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University of Cincinnati
School of Social Work
Mental Health Policy
October 23, 2012
Recovery & Peer Supported Services
Reneé Kopache ~ Mental Health & Recovery Services Board
Agenda
• Overview of recovery
• Overview of peer support
• Matching services & peer support to stages of
recovery
• Integrating peer support with traditional services
• Peer services in Hamilton County
• Statewide Activities of importance
Overview of Recovery
Recovery: What It Is
•
“A deeply personal, unique process of changing one’s
attitudes, values, feelings, goals, skills and/or roles
…recovery involves the development of new meaning and
purpose in one’s life as one grows beyond the catastrophic
effects of mental illness."
Anthony, W. A. (1993). Recovery from mental illness: The guiding vision of the mental health
service system in the 1990’s. Psychosocial Rehabilitation Journal, 16(4), 11-23.
•
In 1999, the Ohio Department of Mental Health defined
recovery as…“the process of overcoming the negative
impact of a psychiatric disability despite its continued
presence.”
• In 2012, SAMHSA defines Recovery for both mental health
and alcohol and substance abuse as “A process of change
through which individuals improve their health and
wellness, live a self-directed life, and strive to reach their
full potential.” SAMHSA (2012). Working Definition of Recovery.
Recovery: What It Looks Like
Values & Beliefs
Pets
Person prior to
mental illness
Person
Work
Values & Beliefs
Pets
Person with
mental illness
Mentally Ill
Work
Values & Beliefs
Mental Illness
Recovery Process
Person
Work
Recovery: The Process
Four Major Dimensions that Support a Life in Recovery:
Home: a stable and safe place to live;
Health: overcoming or managing one’s disease(s) or symptoms—for
example, abstaining from use of alcohol, illicit drugs, and non-prescribed
medications if one has an addiction problem—and for everyone in recovery,
making informed, healthy choices that support physical and emotional
wellbeing.
Purpose: meaningful daily activities, such as a job, school, volunteerism,
family caretaking, or creative endeavors, and the independence, income and
resources to participate in society; and
Community: relationships and social networks that provide support,
friendship, love, and hope.
SAMHSA (2012). Working Definition of Recovery.
Recovery: The Process
Factors important to recovery:
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•
•
•
•
•
•
•
•
•
•
•
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Clinical care
Hope
Support
Work/meaningful activity
Empowerment
Community involvement
Access to resources
Education/knowledge
Self-esteem
Self-help
Spirituality
Physical health
Self-responsibility
• Self-directed
• Individualized and
person-centered
• Holistic
• Strengths based
• Growth oriented
Recovery: The Process
Guiding Principles of Recovery:
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Recovery emerges from hope
Recovery is person-driven
Recovery occurs via many pathways
Recovery is holistic
Recovery is supported by peers and allies
Recovery is supported through relationship and social networks
Recovery is culturally-based and influenced
Recovery is supported by addressing trauma
Recovery involves individual, family, and community strengths and
responsibility
• Recovery is based on respect
SAMHSA (2012). Working Definition of Recovery.
Recovery: The Result
Overview of Peer Support
What is Peer Support
• Grew out of early advocacy efforts (history)
• “Relationships built and nurtured through shared
experiences. People who have liked experiences
can better relate and can consequently offer more
empathy and validation.” (Sherry Mead)
Purpose of Peer Support
• Advocacy
• To utilize shared experiences as a means to
connect with and foster the recovery of other
individuals with a mental illness
• To engage consumers who otherwise may not be
willing to receive services
• To provide a more relaxed relationship
• To compliment clinical services
Evidence: Effectiveness of Support
• Peer support and peer provided services are
considered “promising practices”
• Peers do as well as non-peers on most outcomes
(no significant differences)
• ACT teams with peer specialists have
experienced better outcomes
• Working as a consumer provider fosters
empowerment, self-esteem, and a shift in
meaning and purpose
Matching Support to Stages of Recovery
Stages of Recovery
Dependent/Unaware
(Hope)
Consumer relies on others and is
not aware of his/her own status or
needs.
Dependent/Aware
(Empowerment)
Consumer relies on others but is
aware of his/her status and needs.
Independent/Aware
(Self-Responsibility)
Consumer relies on self and is
aware of his/her status and needs.
Interdependent/Aware
(Meaningful Role)
Consumer relies on self and others
in a mutual exchange of beneficial
support, services and resources.
ODMH (1999) Emerging Best Practices in Mental Health Recovery. Stages in parenthesis
are from the Village Integrated Services, Inc.; Long Beach. CA
Hope
Peer Support:
• Peer support is informal
• Interactions typically occur in treatment settings
• The result of being at the same place at the same time)
• Focus is often on mental illness rather than recovery
• Clinical and family support is often as important as peer
support at this stage
Empowerment
Provider Services:
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Case management
Medical somatic
EBPs
Day/Psychosocial programs
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Skills development (basic)
IMR
Peer support
12-step programs
Focus on stability and helping
consumers gain independence
(do “with” instead of “for”).
Peer Support:
• Becomes more formal
– Often occurs at
agencies/hospitals
– day programs, groups, peer-topeer classes
• Focus begins to shift from
mental illness to advocacy and
recovery
• While clinical support is still
critical in this stage, peer
support takes on increasing
importance
Self Responsibility
Provider Services:
• Reduced medical somatic
• Transition out of case
management
• Therapy
• Vocational services
• Supported
housing/education
• Transition out of
day/psychosocial programs
Focus on self-esteem and
continued empowerment
Peer Support:
• Peer Support takes on an equal, if
not more important role as clinical
support.
• Peer support is more likely to
occur outside the formal
treatment environment.
• Peer support occurring in the
community and is based on
shared interest rather than illness.
• People in recovery begin to “give
back”….they become volunteer or
paid staff.
Meaningful Role
Peer Support:
Provider Services:
– Medical somatic only
services
– Safety net for other
services should the need
surface
Focus on utilization of
natural supports and, for
some, transition from
mental health services.
•
Peer support occurs in the natural
environment.
•
At this point, some individuals
“graduate” from the system and
gain support though non-consumer
relationships.
•
If remaining a part of the consumer
culture, individuals at this stage are
the givers of support…they receive
their support elsewhere.
• Providing support becomes a
meaningful role!
Changes in Types of Peer Support Across Stages of Recovery
12
10
10
10
10
Importance of type of peer support
(10 = most, 1 = least)
10
8
7
7
7
7
6
4
4
4
4
4
3
2
1
1
1
0
Hope
Empowerment
Self-Responsibility
Stages of recovery
non-structured contact (hospital, agency)
peer to peer (classes, support groups)
Tx program/groups
self-help/natural support
Meaningful Role
Support That Hinders Recovery
• Support that doesn’t match the needs and desires
of the individual
– e.g. providing peer-to-peer classes to a person who has
acute clinical needs is far less effective than having a
peer available for that individual to talk to.
• Support that doesn’t encourage and facilitate
growth…that doesn’t help an individual establish
and reach his/her goals
– e.g. doing things for a person that they are capable of
doing for themselves, or learning to do for themselves.
Support That Hinders Recovery
• Support that doesn’t end
– Avoid the Hotel California syndrome…
• when peer support is no longer necessary and/or
beneficial, the person should be encouraged to transition
to something else (i.e. natural supports in the community).
• Support that is controlling
– If the relationship is hierarchical, there’s a problem
• Support that is stigmatizing
– We can’t criticize mental health professionals and the
community for stigmatizing those with a mental illness
if we also do it!
Integrating Peer Support
“Recovery is the
mending process that
reweaves Human
Beings back into the
fabric of our society”
And…
Peer Support is a
critical ingredient of
recovery.
Environments with Peer Support
• Consumer-operated agencies
• Peer-run centers/programs
• Psychosocial and other programs/services at
agencies
• ACT teams
• Hospitals, crisis centers, and emergency rooms
• Jails
Role of Peer Staff
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Foster hope and self-determination
Mentor/role model
Engage
Teach
Support
Advocate/Combat stigma
Serve on boards/committees
Research
Peer Support Competencies
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Encouraging independence
Beliefs supporting recovery
Interpersonal skills
Peer-based program support
Understanding how peers cope
Advocacy
Legal rights and antidiscrimination
Training for work and family life
* Campbell, Dumont, and Einspahr, 1999
Challenges
• Dual roles (role confusion)
• Loss of own support system
• Illness/symptoms
• Inadequate training
• Boundaries
• Rural (one agency) communities
• Job titles
Challenges
• Perceptions of other employees that peer staff
receive favorable treatment
• ADA (accommodations), extended
illness/symptoms
• Employing consumers are providers without
having a culture that supports recovery-oriented
services
• Ethical standards for licensed professionals
• Supervision
Training for Peer Providers
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Train the trainer method/Peer support specialists
Collaboration with community colleges
Recovery Centers
Organizational certification
Consultants/technical assistance centers
Peer services in Hamilton County
• Recovery Center
• Mighty Vine Wellness Club
• Warmline
• Within treatment agencies
(GCB, Core, Central Clinic, IKRON)
Activities at State & National Level
• Ohio Empowerment Coalition
• COS Director’s Association (OCOSA)
• Medicaid billable peer services
– Medicaid elevation
– Currently 29 states have Medicaid billable peer
services….Ohio is trying to become the 30th
– National Standards being developed
– National Credentialing being considered
Resources
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Pathways to Recovery
Wellness Recovery Action Plan (WRAP)
Wellness, Management & Recovery (WMR)
Peer Support Specialists training
Self-determination series
DBSA (dbsa.org)
www.mentalhealthpeers.com
National Association for Peer Specialist www.naops.org
The Institute for Recovery and Community Integration
www.mhrecovery.org
Q&A and Contact Info.
Renee Kopache, [email protected]