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Recovery from Mental Illness: Offering hope through your personal journey
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Recovery from Mental Illness: Offering hope through your personal journey

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Presented by Dr. Atwood, Carlo Verdicchio, and Heather Masson of The Royal's Recovery Program.

Presented by Dr. Atwood, Carlo Verdicchio, and Heather Masson of The Royal's Recovery Program.

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  • Treatment has changed dramatically as well. Often it will be in response to the ideas about the nature of schizophrenia. For example believing that mental illness is a disease and not a moral failure motivated one of the first revolutions in psychiatry. <br /> Moral treatment was a modality introduced by Philippe Pinel who believed that Madness could be treated by treating people nicely. <br /> Pinel spent hours with patients documenting symptoms feeling that this may lead to insight into the treatment and nature of their illness <br />
  • Despite changes in perception about the nature of mental illness the reality was that many patients needed to be held in institutions. Treatment modalities reflect the desperation of the psychiatrists. <br /> Note that ect and insulin coma therapies may reflect a belief that epilepsy and schizophrenia are oppositional states of mind (we will come back to this) <br />
  • Wow, sign me up. <br />
  • Speaker Notes: <br /> * Additional data - Died during first episode = 1%, Pattern of illness cannot be determined = 9% <br /> Reference: <br /> Rosen K, Garety P. Predicting recovery from schizophrenia: A retrospective comparison of characteristics at onset of people with single and multiple episodes. Schizophr Bull. 2005;31(3):735–750. <br />
  • Speaker Notes: <br /> Response to treatment is usually defined by a percentage decrease in symptoms and usually refers to positive symptoms. <br /> Remission, as per APA consensus criteria, is defined as either total absence or presence at a level no greater than mild of both positive and negative symptoms (SAPS-SANS global rating 2 or less or PANSS item ratings of 3 or less). <br /> Recovery is usually defined as functioning independently in areas of work or school, social relationships and independent living and requiring minimal or no support (societal perspective) and, in addition, personal sense of well being (personal perspective). <br /> Reference: <br /> Andreasen NC, Carpenter WT Jr, Kane JM, Lasser RA, Marder SR, Weinberger DR. Remission in schizophrenia: Proposed criteria and rationale for consensus. Am J Psychiatry. 2005;162(3):441–449. <br />
  • data on the annual recovery rate for schizophrenia—the median estimate was 1.4%. Put simply, this suggests that for every 100 individuals with schizophrenia, 1 or 2 individuals per year would meet the recovery-related criteria, and approximately 14% would be expected to recover over 10 years. <br />
  • Social- Negative symptoms, paranoia, depression, amotivation, youth may find it difficult to engage due to stigma <br /> Physical Health- primary health care, nutrition ( lack of resources, poverty, functional defits) <br /> Engagement- depression, paranoia, stigma, financial resources <br /> Finances- job loss, ODSP, stress on marriage, cost of medications and or treatement, disruption in post secondary education <br />
  • I can only offer hope and hold it for you. <br />
  • ?Cut? <br />
  • ?Cut? <br />
  • ?Cut? <br />

Recovery from Mental Illness: Offering hope through your personal journey Recovery from Mental Illness: Offering hope through your personal journey Presentation Transcript

  • Recovery from Mental Illness…Offering Hope Through Your Personal Journey Presented by: Dr. David Attwood, Heather Masson RN CPMHN (C) Manager of Patient Care Services, Recovery Program, Carlo Verdicchio Peer Support Worker
  • Where have we come from………….
  • Other Strategies
  • Prevalence of Schizophrenia • Between 1 to 2 per 100 people in general population will have a psychotic disorder sometime in their lives (Life time risk) • Approximately 24 million have schizophrenia worldwide • Approximate 240,000 Canadians have schizophrenia • Every year 20-25 persons in a population of 100,000 will develop the illness for the first time
  • Course of Illness • Cognitive deterioration begins before onset of psychosis • 25-50% have poor premorbid adjustment • Disease process peaks in first 5-10 years • Duration of untreated illness, as well as number of relapses predict poorer outcome • 55% moderately good outcomes, 45% poor outcomes in 25-40 year follow up studies • Estimated treatment cost greater than for all cancers combined
  • Despite 60 years of Pharmalogical treatments….. • Not everybody responds to antipsychotic treatment • 28 – 35 % of cases are treatment refractory • Response to an antipsychotic tends to be the condition for benefitting from other treatments • At least 30% of patients will not respond to Clozapine • …and Schizophrenia remains…
  • Positive Symptoms Delusions Hallucinations Disorganized speech Catatonia Cognitive Deficits Attention Memory Executive functions (e.g., abstraction) Social/Occupational Dysfunction Work Interpersonal relationships Self-care Negative Symptoms Affective flattening Alogia Avolition Anhedonia Social withdrawal Comorbid Substance Abuse Mood SymptomsMood Symptoms Depression Hopelessness Suicidality Anxiety Agitation Hostility Schizophrenia: The most devastating of illnesses Metabolic Morbidity
  • Hard to stay on track…
  • Trajectories of Clinical Outcome Following a First Episode of Psychosis
  • Gap in Levels of Outcome: A Challenge? • Response: Percentage decrease in symptoms • Remission (APA consensus): SAPS- SANS global rating 2 or less or PANSS item ratings of 3 or less • Recovery: Independent functioning (work, school, social relationships, independent living); requiring minimal or no support (societal perspective) and, personal sense of well being (personal perspective) Andreasen NC, Carpenter WT Jr, Kane JM, et al. Remission in schizophrenia: Proposed criteria and rationale for consensus. Am J Psychiatry. 2005;162(3):441–449.
  • So how are we doing? • Reviews of several hundred studies, 1895 – 2000 – 40 – 42% “Good outcomes” • Recent metanalysis, 50 studies: – 13.5 % met Recovery Criteria – Poorer countries higher than developed countries – No differences in sex, midpoint of intake period, strictness of the diagnostic criteria, duration of follow-up – 1 in 7 individuals with schizophrenia recover. – Despite major changes in treatment options in recent decades, the proportion of recovered cases has not increased. Schizophr Bull. 2013;39(6):1296-1306. © 2013 Oxford University Press
  • Personal Objectives • I treat primarily Schizophrenia • Despite investment of time, medications, resources, Schizophrenia remains a humbling illness • Considering how much attention has been allocated to exploring the onset of psychosis (eg, prodrome and early psychosis), it is appropriate that a comparable degree of scrutiny also be accorded to the recovery of psychosis • Logical, persuasive, coercive techniques often prove ineffective, fail to secure long term objectives, may actually alienate patients from care • The Recovery Program provides some opportunity for outcome enhancement…
  • So this is where we start…..
  • Defining Mental Health Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community. In this positive sense, mental health is the foundation for individual well-being and the effective functioning of a community. World Health Organization (W.H.O.)
  • Mental Health Challenges Can Affect An Individual’s….. • Social Relationships • Physical Health • Ability to engage in meaningful activities • Ability to work or attend school • Finances • Ability to see their own potential
  • Mental Health Commission of Canada, Recovery Recovery…involves a process of growth and transformation as the person moves beyond the acute distress often associated with a mental health problem or illness and develops new-found strengths and new ways of being. Mental Health Commission of Canada, 2010
  • Principles of Recovery • Recovery is about building a meaningful and satisfying life, as defined by the person themselves, whether or not there are ongoing or recurring symptoms or problems. • Self-management is encouraged and facilitated. The processes of self-management are similar, but what works may be very different for each individual. No ‘one size fits all’.
  • Principles of Recovery (cont’d…) • The helping relationship between clinicians and patients moves away from being expert / patient to being ‘coaches’ or ‘partners’ on a journey of discovery. • People do not recover in isolation. Recovery is closely associated with social inclusion and being able to take on meaningful and satisfying social roles within local communities, rather than in segregated services. • Recovery is about discovering – or re-discovering – a sense of personal identity, separate from illness or disability.
  • Quality of Life
  • Hope
  • Peer Support in Recovery “Research findings document that individuals who use peer run services have decreased hospitalizations, suicide rates, and substance use, an increase in social contacts, ability to carry out activities of daily living and a positive impact on participants’ recovery, including an increase in their empowerment, hopefulness, and informal learning of adaptive coping strategies.” J. Campbell in On Our Own Together: Peer Programs for People with Mental Illness:
  • Wellness
  • Wellness From the December 2012 issue of the Canadian Foundation for Healthcare Improvement’s Mythbusters : “…a growing body of evidence is showing that recovery of a meaningful life despite limitations imposed by illness is possible and likely. People with lived experience have known for some time that, with hope, empowerment and support from others, recovery is possible. Promoting a mental health system that views both personal and clinical recovery as the objective can reduce the healthcare costs, enhance quality of life, promote social inclusion, and help those living with mental illness lead full and productive lives.”
  • Recovery Program at the Royal • 32 bed inpatient unit located on the 1st floor of the Royal Ottawa Place. • 3-6 month length of stay • Interdisciplinary Team (Psychiatry, Nursing, OT, SW, RT, Dietary, Peer Support, Pharmacist on site) • Recovery-focused treatment, education and opportunities for skill-building. • A holistic view of mental health that focuses on the individuals strengths, not just symptoms
  • Who do we serve? • Axis 1 diagnosis • Age 18-65 • History of prolonged illness and hospitalization • First episode psychosis • Experiencing significant challenges in his or her ability to successfully function within the community. This is demonstrated by a lack of meaningful activity, social roles or functional ability to manage self-care or live in the community with minimal formal support. • Capable of engaging in the recovery process • Voluntary Program
  • Referral Process • Referral Package complete • Send through internal mail or fax • Reviewed by intake team to determine appropriateness of referral • Team assessment of patient and tour • Wait list • Admission
  • An individual is ready to participate in the program when….. They are able and desire to … • Engage in the recovery process with our interdisciplinary team • Identify short and long term goals • Recognize responsibility for their wellness and recovery • Participate and engage in regular programming
  • Program Goals and Discharge • The goal is for people to move back into the community and live as independently as possible, accessing available community supports. People are discharged when they;  Successfully reach their goals  Demonstrate a level of functioning in activities of daily living required to live in the most appropriate environment of their choice  Progress to a point where they can no longer benefit from the program
  • Treatment “Recovery is described as a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills, and/or roles. It is a way of living a satisfying, hopeful, and contributing life even with limitations caused by illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness.” Anthony (1993)
  • • Treatment in recovery-focused care is: - a collaborative process which focuses on promoting well-being rather than simply treating illness. - Professional staff are encouraged to facilitate a service-user in identifying, developing, and working towards personally meaningful goals for their well-being. - As much as possible, the service user is the ultimate decision-maker for how care is directed.
  • The importance of self-directed goal- setting “It’s not really helpful to do activities just for the sake of doing something, to really make a difference it has to be meaningful.” -patient in the Recovery Program
  • Recovery is Possible for Everyone.. “Persons suffering from mental or physical illness must not define themselves by their illness, but rather the unique individual that they are. Any illness may make your journey through life more challenging. However, recovery is possible for anyone. Recovery is a process in which an individual suffering with mental illness acquires insight into their strengths and abilities, and continues to work toward meaningful goals despite residual symptoms of their illness. Success is not measured by others, but rather the person themselves.” Heather Masson RN CPMHN (C)
  • Luc’s Story Life Before Recovery • Severe depression and delusions • Extremely secretly suicidal • No supports except psychiatrist • Last hope Life in Recovery • Medication Changes • Support Team • Access to a wealth of resources • Friends • Volunteering
  • Luc’s Story cont…. Life After Recovery • Expanded role in volunteering • Friends • Another meds change for the even better • School and work
  • Questions?
  • Resources Allott, P., Loganathan, L. and Fulford, K.W.M. (2002). Discovering hope for recovery: a review of a selection of recovery literature, implications for practice and systems change in Lurie, S., McCubbin, M., & Dallaire, B. (Eds.). International innovations in community mental health [special issue]. Canadian Journal of Community Mental Health, 21(3). Mental Health Commission of Canada www.mentalhealthcommission.ca Changing directions, changing lives. Mental Health Strategy for Canada • Toward Recovery and Well-Being: A Framework for a Mental Health Strategy for Canada • Voluntary National Standard of Canada for psychological health and safety in the workplace released http://www.mentalhealthcommission.ca/SiteCollectionDocuments/January_2013/MHCC_Standar d_MediaRelease_ENG.pdf Centre for Addiction and Mental health www.camh.ca CAMH Knowledge Exchange http://knowledgex.camh.net Canadian best practices portal for health promotion and chronic disease prevention www.phac.gc.ca/cbpp CMHA Mental health promotion tool kit http://www.cmha.ca/mh_toolkit/intro/index.htm Evidence-based mental health promotion resource (VicHealth) www.health.vic.gov.au/healthpromotion/downloads/mhr_social.pdf Gottlieb, L. (2013). Strengths-Based nursing care. Health and healing for person and family. New York: Springer Interactive Domain Model of Best Practices IDM Best Practices website at www.idmbestpractices.ca National Network for Mental Health (NNMH) http://www.nnmh.ca/
  • • http://www.mentalhealthcare.org.uk/recovery