When Recovery is an Expectation
Jean Xoubi is Program Supervisor for Adult Mental Health Services at Metropolitan’s Southwest Center. On Sept. 21, 2016, she spoke at a Mental Health America of Illinois luncheon about the Recovery Model, the basis for our adult mental health services. The person-centered model fosters productive, independent living in the community and helps each person experience positive change.
In 2005, the State of Illinois Dept. of Mental Health was strongly encouraging Metropolitan and other mental health providers to implement the Recovery Model. They wanted consumers to eventually graduate from the program so they wouldn’t be consumers for life.
The Recovery Model was a hard sell to staff at the beginning. In our Community Integrated Living Arrangement (CILA) program, I remember staff looking at me like I had two heads. They would say, “What about so-and-so? She hasn’t left her apartment in more than 12 years. She’s got so many medical problems, she’s not going anywhere except a nursing home. Why are we forcing her to do these things?”
Then I asked them, “Well, what kind of outcome do you want for her? Her next destination might be a nursing home, but do you want her to be able to make friends there? Do you want her to be able to communicate her needs to the staff, so she’s not isolated and afraid, and not getting her needs met?” They couldn’t really argue with that.
So we focused on starting with consumers where they were, and then moved on accordingly to help them reach their highest possible potential. And that’s different for every single consumer we work with.
Person-first language can be the first and most significant steps in recovery – a “person living with mental illness” vs. “she’s schizophrenic.”
First, the consumer defines their own recovery-based life goals and gets help designing a service plan to achieve those goals. Staff provide counseling, support, and a sense of hope to consumers as they strive to achieve goals they may have thought unattainable.
A philosophy of self-advocacy by the consumer replaces the traditional advocate role of staff: The case manager role is one of coaching and mentoring instead of oversight. Consumers learn that they have unique skills and capacities that are used every day to help them succeed and be more self-reliant. Through skill-building exercises, consumers achieve their identified goals. They identify barriers and challenges to their recovery, and prepare to overcome them.
Metropolitan’s holistic approach makes the difference. To help consumers achieve and maintain their recovery goals, we provide a wide variety of individual and group services.
Counseling and therapy for individuals, families, and groups are based around the needs of the consumers. Many consumers spent their adolescence in and out of the hospital, when the rest of us were learning how to prepare for adult life, so we start with basic skill building, like cooking, budgeting, and communicating effectively. Many suffered trauma like abuse in childhood or violence in the community, so we developed group programming related to trauma such as art therapy. Consumers with personality disorder illnesses have access to group services, such as dialectical behavior therapy to address mood swings, that help them get along better in the world.
Case management in the Recovery Model is “doing with and teaching how,” instead of “doing for.” Rather than doing tasks for the consumers, case managers link them to community resources such as public entitlements, financial assistance, housing and medical services, and coach consumers through accessing them.
One consumer needed to be hospitalized to have her medication adjusted, but she was terrified that DCFS would take her children away. We were able to help her contact relatives and resolve the situation, but if the plans were made in advance she could focus solely on getting well. That is why we work on crisis planning.
Community-based supports, including family members, community services and consumer networks, help ensure the consumer’s long-term success after program graduation. Rehabilitative services teach skills to identify and develop these community-based supports, manage the activities of daily living, to live and work in the community autonomously and achieve the highest level of independence possible.
Crisis Prevention and Intervention: We help consumers identify triggers to a potential relapse, develop a contingency plan to prevent psychiatric crisis situations like hospitalization, and use crisis planning to minimize the negative impact when they do experience a crisis. Just like there are advanced directives for medical care, we help them develop advanced directives for when they are incapacitated and unable to make decisions for themselves. Some directives are simple such as who takes in the mail or informs their employer they won’t be in to work. Others are more complex, like identifying a guardian for their children or determining who has power of attorney over their finances so the bills can continue to be paid.
Psychiatry is the linchpin in our mental health services. Medical doctors and nurses provide services such as evaluation and ongoing medication management.
Peer Mentorship: Often when someone is seriously mentally ill, society and family members lower their expectations for what this person will be able to do. As a result, people often come in for mental health services feeling demoralized and or even entitled. So peer mentors are able to show, “If I can do it, so can you.” They can share their story in a way that a staff person isn’t able to.
From experience, we know the Recovery Model works. Since we started using the model our CILA program has graduated 19 people who now live independently in the community – none have come back. Some have gotten jobs and gone back to school, and been able to reconnect with family.
For example, there’s Deborah, a consumer we worked with a few years ago who experienced sexual trauma while in the military. She didn’t feel comfortable going to any of the military hospitals such as the VA because she couldn’t tolerate the lobby experience, sitting there with a bunch of men. We were able to have her come early in the morning to our Southeast Chicago Center and brought her right to the therapist. This is an example of how we tailor what we do to individual consumers. The end result is that she became a Peer Mentor. She went back to school, and now she has a full-time job.
Every client’s story is different. Take a severely psychotic person – success for him or her can be something as basic as being able to order a meal at fast food restaurant. It’s something they couldn’t do before help was provided through the Recovery Model. These are baby steps for many people, but it’s very meaningful to them.
Not everyone is going to go on to college, get a job and move into the community. But the Recovery Model improves the quality of their lives even if they’re not making drastic jumps. Think about the CILA client I mentioned earlier, the one who didn’t leave her apartment for 12 years. Toward the end of her stay with us, she was going to baseball games, attending parties and other activities, and having the most fun she had had in a very, very long time.