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Integrating Recovery and Community Concepts into Behavioral Health Practice
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Integrating Recovery and Community Concepts into Behavioral Health Practice

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Mark Salzer is the Director of the Temple University Collaborative on Community Inclusion of Individuals with Psychiatric Disorders. The Collaborative is funded by the National Institute on Disability …

Mark Salzer is the Director of the Temple University Collaborative on Community Inclusion of Individuals with Psychiatric Disorders. The Collaborative is funded by the National Institute on Disability and Rehabilitation Research (NIDRR) whose research focuses on what kinds of things support people with schizophrenia, bipolar disorder, and major depression to live in their communities like everyone else. Salzer recently gave this presentation on Brainshark.com.

As Salzer explains in the presentation, the numbers of people living in state mental hospitals and institutions has decreased dramatically—from just under 370,000 in 1969 to just over 41,000 in 2011. “However, while more people with mental illnesses are now living in the community… they are not of the community like everyone else.”

Published in: Healthcare, Health & Medicine

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  • 1. v Mark Salzer, Ph.D. Professor and Chair Department of Rehabilitation Sciences, Temple University Director, Temple University Collaborative on Community Inclusion (www.tucollaborative.org) Integrating Recovery and Community Concepts into Behavioral Health Practice
  • 2. My Introduction to Recovery and Community Inclusion: Ann the Person
  • 3. My Introduction to Recovery and Community Inclusion: Ann the Person Hi. My name is Mark Salzer. I am a clinical psychologist who has worked with people diagnosed with schizophrenia and other psychoses, bipolar disorder, and major depression in public mental health systems for approximately 25 years. During this time I have provided clinical services, conducted research, and taught mental health providers.
  • 4. My Introduction to Recovery and Community Inclusion: Ann the Person At the beginning of my career, soon after graduating with my bachelors degree in psychology and sociology, I worked as a psychiatric technician at a locked, acute psychiatric unit in Minnesota where I grew up. Part of my job involved going around the unit every hour to make sure that people were still there. One day I was making my rounds and knocked on the door of a young women who had been admitted a few days earlier for a suicide attempt. There was no answer. I knocked again. No answer.
  • 5. My Introduction to Recovery and Community Inclusion: Ann the Person I finally entered the room and found her crying hysterically on her bed. I had never seen someone cry so hard in my life. All I could think of while I stood there was about her illness, that she was depressed, and that she might want to kill herself. I was thinking about calling a nurse or a doctor for help. Thankfully, I did what likely turned out to likely be the best thing – I sat down in the chair next to her bed and listened.
  • 6. My Introduction to Recovery and Community Inclusion: Ann the Person I expected to hear her talk about her depression, how suicidal she was, and other similar, symptom- oriented thing. Instead, she started talking about she had just recently gotten married and was worried about how her husband was going to respond to her hospitalization. “He is going to think he married a lunatic who can’t keep out of the hospital,” she said.
  • 7. My Introduction to Recovery and Community Inclusion: Ann the Person She was worried about how her family was going to react to her hospitalization. She was concerned about losing her job. She was essentially worried about the same types of things that I think about in my life – relationships, work, school, and other meaningful things in her life, how they were effected by her mental health issues, and I would now say, how they, and especially losing participation in these areas, may effect her mental health.
  • 8. My Introduction to Recovery and Community Inclusion: Ann the Person This experience led me down the road to seeing people with mental illnesses as people, not just patients, and to understand the importance of a recovery and community inclusion orientation to how we provide all mental health services.
  • 9. Perspectives on Recovery (Bellack, 2006) • Medically-oriented perspective – focus on symptom reduction; improved functioning; decreased hospitalizations • Consumer-oriented perspective – Living a satisfying, fulfilling, and hopeful life with or without symptoms of one’s illness – Development of new meaning and purpose as one grows beyond the catastrophic effects of mental illness
  • 10. Community Integration and Inclusion • Community Integration: “The opportunity to live in the community, and be valued for one’s uniqueness and ability, like everyone else.” (Salzer, 2006) • Community Inclusion means actively working to bring people who have historically been excluded to "come in” to the community (to participate) (Marsha Forest Centre -- http://www.inclusion.com/inclusion.html)
  • 11. More people in the community…. (All Data From Annual report -- Admissions and Resident Patients, State and County Mental Hospitals, United States. Rockville, MD: Center for Mental Health Services except * 2011 CMHS Uniform Reporting System (URS) Output Tables (page 9) Year 1969 1984 1990 1998 2004 2011* National 369,969 114,055 90,572 63,765 52,632 41,249 # of Individuals in State and County Hospitals at the End of the Year
  • 12. …but NOT OF the Community • Housing • Education • Employment • Financial independence • Limited social roles • Atrophied leisure/recreation • Limited attention to spiritual issues • Limited encouragement to vote • Limited self-determination Salzer et al., in press
  • 13. Would, Could, and Should Participate • Would - People with serious mental illnesses want – Work – Good place to live – Relationships • Could – With the proper supports people can – Lived independently in the community – Work in competitive jobs – Go to college and university – Develop friendships and peer relationships • Should – Participation has been found to have numerous positive benefits
  • 14. Behavioral Health Workforce Needs • Well trained, committed workforce across the mental health system • Recovery and community inclusion concepts need to permeate all aspects of what staff do on a day-to-day basis • Quality training makes a difference • Building careers ladders may enhance long-term connections to the behavioral health workforce • Work-based learning opportunities are important for knowledge and skill development
  • 15. The Time is Now! “We don’t have to lose another generation to a life outside of the mainstream, If we act now – in our practice, programs, and policies - to promote community integration.” - Richard Baron 15
  • 16. For More Information Click Here! Click here!
  • 17. References • Bellack, A. S. (2006). "Scientific and Consumer Models of Recovery in Schizophrenia: Concordance, Constrasts, and Implications." Schizophrenia Bulletin 32(3): 432- 442. • Salzer, M.S. (2006). Introduction. In M.S. Salzer (ed.), Psychiatric Rehabilitation Skills in Practice: A CPRP Preparation and Skills Workbook. Columbia, MD.: United States Psychiatric Rehabilitation Association. • Salzer, M.S., Baron, R.C., Menkir, S-M A., & Breen, L. (in press). Community integration practice: Promoting life in the community like everyone else. In P. Nemec & K. Furlong Norman (Eds.). Best practices in Psychiatric Rehabilitation. Columbia, MD.: United States Psychiatric Rehabilitation Association.

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