The American Psychiatric Association and Recovery from Mental Illness

from the

AMERICAN PSYCHIATRIC ASSOCIATION ANNUAL MEETING

MAY 19-24, 2007 - San Diego, Calif.

The William C. Menninger Memorial Convocation LectureNobel laureate John Nash Jr., Ph.D., at the age of 30, descended into the debilitating blackness of severe paranoid schizophrenia. Despite the odds, however, his perseverance and genius eventually led to his winning the 1994 Nobel Prize for Economics for landmark work he had begun in the 1950s on the mathematics of game theory. Yet, this is no fairytale ending; it provides powerful support for the growing movement within psychiatry to help patients with severe mental illness focus on recovery, not pathology.

Lecture given by Professor John F. Nash, Jr.





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From a 1998 PSYCHIATRIC NEWS

"The philosopher Henry James once said that three things in human life are important: "The first is to be kind, the second is to be kind, and the third is to be kind,"Joel Feiner, M.D., in a lecture on the evolution of community psychiatry at APA's 1998 Institute for Psychiatric Services last month in Los Angeles.



Feiner's belief that proper attachments in rehabilitation are critical to recovery from psychiatric illness.

The therapist's positive view of the patient allows the patient to feel valued. "When a person feels valued, he is willing to risk new things and try new behaviors," Feiner said.

The interaction between case manager and patient is critical, but high turnover means that case managers often leave, severing the patient's link to the psychiatric clinic. It is therefore risky to let patients invest a great deal emotionally in their relationship with the case manager, he added.

The relationship between the clinician and the patient should take precedence over the relationship between the caseworker and the patient, since in most cases, the clinician is far more likely to remain accessible than is the caseworker, observed Feiner. When a good relationship between clinician and patient is not established, compliance is undermined. Mental Health Connections has a high level of compliance, although noncompliance in most mental health programs is a huge problem, said Feiner.

About half the patients in most other programs are medication noncompliant in the first year after discharge, he observed. Noncompliance is costly in both human and economic terms, resulting in unnecessary hospitalization, lost productivity, additional treatment, and death, Feiner noted. Another cost of noncompliance is "compassion fatigue," sometimes called "burnout," among overworked psychiatrists".

Psychiatrists can contribute to the Recovery paradigm

bird nest




According to a recent article in Psychiatric News to make a significant contribution for patient's recovery psychiatrists need to,

1. Establish more standardized training on the principles of recovery for medical students, residents, and practicing psychiatrists.

2. Expose psychiatry residents and practicing psychiatrists more consistently to patients who have achieved recovery.

3. Redefine the role of community psychiatrists to emphasize their importance in supporting recovery to ensure that they have more time to spend with patients working on recovery issues and reintegrating them into the community.

4. Contribute to the development of best-practice guidelines that describe a range of approaches that support recovery goals.

5. Specify recovery-oriented outcomes within federal, state, and local mental health systems to ensure that psychiatrists focus on practical recovery-oriented goals.

6. Continue to establish partnerships with consumer mental health advocates and groups to further policies that support recovery-oriented systems of care.

7. Transform the public mental health system to emphasize recovery and principles of integrated community care.

8. Advocate for increased funding for a wide range of services in community settings for people with serious mental illness.

9. Lead community education campaigns to highlight the discrimination and stigma encountered by those with serious mental illness.

10. Advocate for elimination of discriminatory policies such as zoning exclusions and custody arrangements that penalize people with mental illness and for increased public funding for services that help to eliminate stigma-based policies.


references:
Promoting Recovery: Recommendations for Psychiatrists, Psychiatric News September 7, 2007 Volume 42, Number 17, page 10, American Psychiatric Association.

Two-Way Street Crucial to Fostering Recovery, Eve Bender, Psychiatr News 2007 42: 10.

Recovery from Mental Illness Ethics 101

PATIENT EMPOWERMENT IS ONE OF THE WAYS WE CAN HELP PATIENTS HELP THEMSELVES.

BUT THERE ARE RISKS IN DOING SO. READ BELOW:


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On the subject of patient self-management the authors of this article published in Bioethics Volume 21 Issue 5 Page 243-250, June 2007 point out that,


“Four central ethical issues can be identified:

1) insufficient patient/family access to preparation that will optimize their competence to SM without harm to themselves,

2) lack of acknowledgement that an ethos of patient empowerment can mask transfer of responsibility beyond patient/family competency to handle that responsibility,

3) prevailing assumptions that preparation for SM cannot result in harm and that its main purpose is to deliver physician instructions, and

4) lack of standards for patient selection, which has the potential to exclude individuals who could benefit from learning to SM. Technology assessment offers one framework through which to examine available data about efficacy of patient SM and to answer the central question of what conditions must be put in place to optimize the benefits of SM while assuring that potential harms are controlled.



Reference: BARBARA K. REDMAN from the Wayne State University, and University of Pennsylvania Center for Bioethics

Barbara K. Redman, PhD, RN, FAAN, Dean and Professor, College of Nursing, Wayne State University, Cohn Building, Suite 12, 5557 Cass Avenue, Detroit, MI 48202.

RESPONSIBILITY FOR CONTROL; ETHICS OF PATIENT PREPARATION FOR SELF-MANAGEMENT OF CHRONIC DISEASE, Wayne State University, and University of Pennsylvania Center for Bioethics



Web reference of the summary: http://www.blackwell-synergy.com/doi/abs/10.1111/j.1467-8519.2007.00550.x

Excerpt from an important review of an important book

Read the entire story at http://psychservices.psychiatryonline.org/cgi/content/full/58/8/1128



"Psychiatry is in an era of change not only in terms of new scientific models of mental health but also in values-based models of psychiatric service. Our nation's first two commissions on mental health were appointed by President Kennedy in 1963 and by President Carter in 1978. The third commission, the New Freedom Commission appointed by George W. Bush, sets a vision for recovery in its budget-neutral document, Achieving the Promise"

.....

"If recovery is a scientific model, then more review could have been invested not only in those areas of the field where recovery easily informs our understanding of illness and outcome but also in areas where recovery has challenges in explaining service provision and certain other phenomena. If recovery is a values-based model, then additional attention to the ethics of recovery or the complex issues of how recovery is balanced by public and personal safety would have helped".


Reference:

Jabbarpour, Yad. M. (Book review) Psychiatr Serv 58:1128, August 2007 American Psychiatric Association

Book Reviewed
Recovery From Severe Mental Illnesses: Research Evidence and Implications for Practice, Volumes 1 and 2
edited by Larry Davidson, Courtenay Harding, and LeRoy Spaniol; Boston, Center for Psychiatric Rehabilitation, 2005, 511 pages and 448 pages, $49.95 each, softcover

Mental Illness Facts

"Let me read this to you, Recupero".

Pura Sobriedad still insists that he learn more about mental health. She knows he has suffered for many years a combination of conditions from which he, we hope, can recover.


"Mental illnesses are medical conditions that disrupt a person’s thinking, feeling, mood, ability to relate to others, and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life.

Serious mental illnesses include major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder (OCD), panic disorder, post traumatic stress disorder (PTSD), and borderline personality disorder. The good news about mental illness is that recovery is possible".

"This is from the NAMI website. Does it make sense to you Recu?"

"It does. But let's read some other day. I am about to see my doctor soon today. Last time he said I was improving and he was startled that I am in the work therapy program. I feel much better and am going through the problems others face at work... I guess that's normal".

"One minute". She insists. "It goes on"

"The best treatments for serious mental illnesses today are highly effective; between 70 and 90 percent of individuals have significant reduction of symptoms and improved quality of life with a combination of pharmacological and psychosocial treatments and supports".

"OK. See you later". Recupero left in a hurry to catch the train to his doctor's office.

Mental Illness Prevention and Recovery Week

These photos show part of the educational activity a the San Juan VAMC (part of the now formally called the VA Caribbean Healthcare system) during the Mental Illness Prevention and Recovery Week. See also more photos on the September 09/09/ 2007 link on the left.

In order of photos:
State Police Band lifts spirits
Center Director starts the program.
Chief of Staff
Chief of Psychiatry and Suicide Prevention Coordinator (and lady master of ceremony)
Chief of Psychology
Chief of Social Work
Procurador del Veterano in Puerto Rico
Nursing Supervisor
Mental Illness Recovery Coordinator
Master educator nurse with information for the public
Psychologist inspiring for Recovery
Psychologist teaches on life transitions and change
Psychiatrist speaking with hands
Well known leader in preventing suicide in Puerto Rico
Chief of Ambulatory Psychiatry and Chief Psychologist with program speakers
Psychiatrists speaks about hope and empowerment
Social workers works with the public on the concept of Recovery
Nurse listens to a question from the public after her talk
Occupational therapist on the motivational trail
vocational Rehabilitation Specialist on recovery
Vocational rehabilitation specialist ready to talk about Compensated work therapy

Recupero rejoiced

"Pura I see a lot of going on lately....in the island. they are celebrating mental health month. Here is the list of activities. I see the VA is also getting into the action". He got off the bar stool at his house. Now Recupero Seguro has no rum in the bar. Bottles have been replaced by books on self-help and psychology.

"Let me see...." Oh Yesss!....Looks like a nice plan for the month", Pura said.



Community Activity
NAMI PUERTO RICO

INVITACIÓN A CONFERENCIA DE PRENSA
PROCLAMA DEL MES DE LA SALUD MENTAL 2007

Fecha: Lunes 1ro de Octubre de 2007
Hora: 10:15am
Lugar: RESTAURANT EL ZIPPERLE
Avenida Roosevelt, Hato Rey, PR
Teléfono: 787-607-4983 Fax: 787-274-0296
Contacto: Silvia Arias, Ph.D. – Directora Ejecutiva NAMI Puerto Rico




President of the Senate invites to Mental Health Month Proclamation
at the Capitol in San Juan





Mental Illness Awareness Week
October 8-12, 2007
San Juan VA Caribbean Healthcare System


Monday October 8, 2007 HOLIDAY COLUMBUS DAY
NO ACTIVITY

Wednesday October 10, 2007
Nestor J Galarza, MD (Local Recovery Coordinator) Medical Service Staff Meeting
12:30 PM Recovery Paradigm Education

Wednesday October 10, 2007 Pharmacy waiting area
1 PM Conversations
Melissa Rivera, PsyD Positive Thinking
James Hickey, PsyTech Recovering from mental illness


Friday 12 October, 2007 Pharmacy waiting Area
1PM Conversations

Maria Mastache, VRS Work as therapy

Jose Pando, PhD Depressed men and impotence



Other activities:October 15-24, 2007

Local Review Coordinator visits
Monday October 15, 2007 Geriatrics and extended care
Mental Illness Recovery Paradigm 1:00 PM

Wednesday October 17, 2007 Dental Service Staff
Mental Illness Recovery Paradigm 7:30AM

Thursday October 18, 2007 Nursing staff
Menta Illness Recovery Paradigm 11:00AM

Wednesday 24 October 2007
Mental Illness Recovery Paradigm Psychiatry Service
1:00PM

In planning for the near future:
Auditorium
Enrique Zamot Mercado, MSW Iraq and the Puerto Rican Family Alexis Lugo Mas, MSW
Discussants: Antonio Sanchez, MD Chief of Psychiatry
Luz Enid del Valle, MSW Returning Vets Program

October Mental Health Month in Puerto Rico

Coming up

MIAW and Mental Health Month in Puerto Rico

Mental Illness Prevention and Recovery Week

These pictures show some of the activity going on at the Caribbean Healthcare System in San Juan, Puerto Rico on the last day of the Mental Illness Prevention and Recovery Week, our inauguration of a long-term process of internal re education on the concept of recovery. (photos by Recupero Seguro)






Marisel Rios, MD, Eddie Echevarria, PsyD and Carlos Calderon,MSN waiting for visitors to arrive at the information table.












Lions Club and VA Volunteers help together at the coffee and cake table.











Rosa Gonzalez, MSN engages the public in conversation about preventing suicide









Rafaela Nieves, MSN discusses recovering from addictions. She must be celebrating her 37 years in the VA System.









Maritza Grau, MSW teaches the concept of recovery from mental illness










James Hickey, PsyD speaks about recovery and decision-making








Carmen Parrilla, PhD discussed prevention of suicide with Antonio Sanchez, MD Chief of Psychiatry and the audience a the VA Auditorium.

Veterans Hospital celebrates Recovery Week

The VA Hospital in San Juan, Puerto Rico has been celebrating the Mental Illness Prevention and Recovery Week from 10 - 14 September 2007.


Part of the celebration included a luncheon with leaders of self-help groups in the local community. NAMI Puerto Rico and Recovery Inc leaders shared their experiences after many years of efforts to combat mental illnesses and the stigma of mental illness in this hispanic society.

Here are some of the photos taken today at this luncheon.




Left to right: Silvia Arias, NAMI
Santiago Reyes and Carmen Awilda Colon, Recovery Inc



Rosa Gonzalez, MSN,
Antonio Sanchez, MD Chief of Psychiatry
Ilsa Torres, MSN, Nursing supervisor
Juanita Lugo, MSN Nursing Supervisor





Nestor J Galarza, VA Local Recovery Coordinator
Luis Arias from NAMI
Rosa Gonzalez, VA Suicide Prevention Coordinator and
Julio Ribera, VA Chief of Psychology



sitting in the back row:
Marisel Rios, MD Chief Ambulatory Mental Health Services
Ana Torres Martin, MD Director Psychiatric Residency
Nivia Baez, Secretary to the Chief of Psychiatry

coming up: patient group response to Pura's letter

Looking for more Pura-Recupero dialogue

An investigation is underway to publish more of the Pura - Recupero dialogue.
If you have clues let us know.

Pura letter discovered

Secret letter found. It is a confidential matter between Pura and Recupero. Keep it confidential, please. Do not put it in the internet. (I guess few people can read it in Spanish). Thanks. ;)





Agosto del 2007


Apreciado Recu:

Me dijeron que no te importo. Que lo único que te importa es la bebida y el cigarrillo. Pero yo se que dejaras de beber y fumar. Te vas a recuperar y volverás a mí. Yo te puedo ayudar ahora y siempre. No dejes que tu condicion mental te lleve al alcohol. Todavía hay esperanza y te estoy esperando.
Tuya,

Pura Sobriedad


PD. Si ya no estas bebiendo dimelo. Dime como haces para recuperarte. Creo que tenemos esperanza.

changing the mental health law

"Great. See what's happening in the island? the Senate is working on amendments to the Mental Health law. I wish it helps people with problem drinking...and.." Pura did not finish her sentence.

Lifitng his eyes from a book Recupero said:
What you mean? I do not trust politicians. Only give lip service to caring for people."

With a long look at him, Pura recoiled:
"You surprise me. Often you are positive on things. What is going on?"-

"I'm not feeling well. I am trying too hard, I think"-

"Take it easy. You have gone a long way, You do not suffer the symptoms you told me about ...any longer, Don't you?" Pura the counselor spoke.


"I still do. But getting over them is a hard part of my life. I also feel down sometimes."

"You know yourself well. Good. You'll see how you'll feel better again."
-I am talking about the public hearings on the mental health law this week. Psychologists, psychiatrists, social workers and patient groups will be telling Senators about what they want. Is'nt that great!"

Submitting to the idea Recupero softly said:
-if you say so....

"I found a psychiatrist's statements in the net. Let me write it the URL down for you.. Here. Perk up Rec."

http://www.prpsnewsletter.blogspot.com

Recupero Seguro on what the job is

Mr. Recupero:
"I searched the internet last night at the hotel and found some VA hospitals are looking for staff to fill positions for recovery coordinators. I read what the job for recovery coordinators in the VA system is. Let me read it to you. It says:

[Serves as Local Recovery Coordinator (LRC) to assist in implementation of policies and procedures from the National Recovery Coordinator (NRC).

Functions as a champion and advocate for the recovery model. Also serves as a recovery ombudsman to the Mental Health Service Chief, program managers, and staff on recovery and implementation of recovery oriented services.

In conjunction with the Chief of Mental Health, develops a 3-5 year plan for the facility that identifies staged implementation of recovery oriented services. Responsible for coordinating the evaluation of recovery implementation and reporting results to the National Recovery Coordinator (NRC).

With the guidance of the NRC, the LRC will implement measures to assess recovery policy and procedure adherences, as well as assess that the recovery model is embodied in the Mental Health programs.

Develops a facility recovery education plan for providers and for veterans and their families. Develops an ongoing education plan for providers. Develops an ongoing education plan for veterans and their families.

Serves as a consultant to Mental Health programs and recovering veterans in development of peer support groups, consumer counseling, and consumer operated services. When available, community resources will be utilized.

Also will also spend no more the 25% of time engaged in direct clinical services, providing recovery oriented care to seriously mentally ill veterans].




I think I will apply for this job".


Ms Pura: "Me too."

Alexandria, Pura and Recupero

Pura:
"Here we are after a long delay a the San Juan airport. Sure is good to rest at this nice hotel in Old Alexandria. Great view of the city from the window!"

Recupero:
"Let me tell you something. I have been afraid to fly all my life but this training is very important for us. Did you know that the President's 2003 Commission on Mental Health is likely to have a better outcome than another of President Bush's decisions that same year?

Pura:
"What d'you mean?"

Recupero: "I am talking about the war. Both going into war in Iraq and the new paradigm on recovery started the same year".

Pura: "I see. But that has little importance now. Let's move to the training site. It all starts at 10am but we have to sign up earlier. The hotel has complimentary coffee at the lobby."

Living drama

Here you will read about a living drama.

Pura Sobriedad is a virtual (fantasized) character that roams the Substance Abuse Program since 1994. She seduces patients into sobriety (origin of her last name).

Now she will join Recupero Seguro in a dialogue on sobriety and recovery. Recupero Seguro is a character with a positive outlook of the world.


Playfulness and humor have a psychological impact on people. Playfulness and humor helps to avoid professional burn-out and is one of the human activities that sustains our mental health.

Any similarities with living or deceased health care professionals is not an accident. It is a purposeful conspiration.

New paradigm in town

"The new paradigm, mental health recovery, has had a boost back in 2003 with the President's Commission on Mental Health. But I am more used to the recovery concept while watching people grow out of dependence ....from drugs or alcohol. That was my job since 1994, to promote quitting and staying quit.

Can recovery also happen to people with other mental illness? Or is it that there is no such thing as mental illness, like Thomas Szasz used to say?
Listen but not necessarily believe him at www.youtube.com/watch?v=Lk4hWWPv9EY


Pura Sobriedad

fumamos menos

La inteligencia emocional se nota en aquellas decisiones que cada uno de nosotros hace para mejorar la calidad de la vida personal. Este mejoramiento en la calidad de la vida personal se traduce en una mejor calidad de vida para familias y grupos particulares.

Se espera que esos cambios positivos se multipliquen en la comunidad circundante.

Yo he trabajado personalmente desde el 1994 en ayudar a cientos de personas a dejar el alcohol, las drogas y la nicotina. Esa temporada ha resultado en una sensacion de utilidad y una satisfaccion personal que comenzó ambiciosa, pasó por obsesiva y se convirtió en la llama de la inspiración para aportar desde el proximo mes de julio del 2007, al nuevo paradigma en el sistema de salud del Caribe para Veteranos, la recuperacion.

La disminución de riesgos a la salud es una forma de recuperación.
Aqui les repito la buena noticia que aparecio hoy en el Nuevo Dia sobre la tasa de fumadores.
Felicitamos a nuestros legisladores y al sistema de salud de Puerto Rico.
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En disminución los fumadores adultos en la Isla

Por Sandra Morales Blanes / end.smorales@elnuevodia.com

16,000 personas mayores de edad dejaron de fumar entre 2006 y 2007.
Salud tiene la meta de bajar un 10% el porcentaje de fumadores para el 2010.
El porcentaje de fumadores adultos en Puerto Rico se redujo de 13.1% en 2005 a 12.5% en 2006, lo que se traduce en 16,000 fumadores menos y un ahorro para el Estado de $56 millones en servicios médicos y pérdida de productividad por enfermedades asociadas al tabaquismo.

Así lo dio a conocer Antonio Cases, director de la División para el Control y la Prevención del Tabaco del Departamento de Salud durante una conferencia de prensa con motivo de la celebración ayer del Día Mundial de No Fumar.

Señaló que desde 1999 en Puerto Rico se ha registrado una baja en los fumadores adultos.
La agencia tiene como meta que el porcentaje de consumidores de tabaco baje a un 10% para el 2010.

Cases atribuyó la reducción estadística a la aprobación de la ley anti-tabaquismo en 2006 y la campaña de educación que le antecedió antes de entrar en vigor en marzo pasado. El funcionario recordó que existe una línea de apoyo gratuita para personas que deseen dejar de fumar: 1-877-335-2567.

Antonio Caces, es director de la División de Control y Prevención del Tabaco, “La reducción se traduce en 16 mil fumadores menos”.

Vamos a crecer 3

/27/2007
transformacion del programa de radio
el programa de Radio Vamos a Crecer se transforma.

quedamos muy agradecidos de Radio Isla 1320 y Media Power por el apoyo que nos brindaron cuando al permitir usar sus microfonos y dedicada y profesional empleomania para la difusion de Vamos a Crecer. Trasmitimos con efectividad los domingos de 4 a 5 de la tarde desde octubre 15 del 2006 hasta el 27 de mayo del 2007.


Vamos a Crecer 3 sera desde este momento un foro para articulos y opiniones sobre el nuevo paradigma y concepto de la recuperacion

Publicado por Nestor J Galarza, MD los 3:36 PM