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Project GREAT: Project GREAT: Bringing Consumerism to Mental Bringing Consumerism to Mental Health Education and ServicesHealth Education and Services
Department of Psychiatry and Health BehaviorMedical College of Georgia, Augusta, GA
Project GREAT: Project GREAT: Bringing Consumerism to Mental Bringing Consumerism to Mental Health Education and ServicesHealth Education and Services
Department of Psychiatry and Health BehaviorMedical College of Georgia, Augusta, GA
Gareth Fenley, MSW Certified Peer Specialist
Alex Mabe, PhD Professor and Chief of Psychology
Joseph S. Ricci, PhD Administrative Director
Gareth Fenley, MSW Certified Peer Specialist
Alex Mabe, PhD Professor and Chief of Psychology
Joseph S. Ricci, PhD Administrative Director
•; ;
“…the mental health delivery system is fragmented and in disarray.”
“…the mental health delivery system is fragmented and in disarray.”
Source: New Freedom Commission on Mental Health (2003). Achieving the promise: Transforming mental health care in America. Final Report. DHHS Pub No. SMA-03-3832, Rockville, MD.
Mental Illness Affects People in the Prime of Their Lives
Mental Illness Affects People in the Prime of Their Lives
Half of the lifetime cases of mental illness begin by age 15 and three-quarters by age 24
About half of Americans will meet criteria for a DSM-IV Disorder in their lifetime.
Kessler, et al., 2005
Use of Mental Health Services- AdultsUse of Mental Health Services- Adults
National Comorbidty Survey Replication Study- Wang et al., 2005
Between 2001 and 2003,
60 percent of individuals with a mental disorder got no treatment
Use of Mental Health Services- Serious Mental Illness
Use of Mental Health Services- Serious Mental Illness
National Comorbidty Survey Study- Kessler et al., 2001
55 percent stated that they had not received services because they did not need it.
Use of Mental Health ServicesUse of Mental Health Services
National Comorbidty Survey Study- Edlund et al., 2002
Delays in making treatment contact range from 6-8 years for mood disorders and 6-23 years for anxiety disorders.
10% dropout by the 5th visit, 18% by the 10th visit, 20% by the 25th visit.
National Comorbidty Survey Replication Study- Wang et al., 2005
Medication Regimen AdherenceMedication Regimen Adherence
Noncompliance rates well over 50% for most medication treatments of major psychiatric disorders – often not detected by the provider.
0102030405060708090
100
1980 1990 2000 2006
Area 1
Line 6
Line 5
Line 4
Line 3
Line 2
Access to High Quality CareAccess to High Quality CareIn the National Comorbidity Study: 78.2 % of mood disorders and 95.9% among nonaffective psychoses did not receive minimally adequate mental health treatment
•Wang, Berglund, & Kessler, 2000
Have Psychiatrists Become Medication Managers?
Have Psychiatrists Become Medication Managers?
•Olfson et al., 2002
From 1987 to 1997:
Percent of patients receiving medications doubled.
Average number of visits declined from 12.6 to 8.7.
Traditional Psychiatric Care Traditional Psychiatric Care
Case Vignette
StigmaStigmaSurgeon General’s Report on Mental
Health of 1999, “…despite unprecedented knowledge
gained in just the past three decades about brain and human behavior, mental health is often an afterthought and illnesses of the mind remain shrouded in fear and misunderstanding.”
Surgeon General’s Report on Mental Health of 1999,
“…despite unprecedented knowledge gained in just the past three decades about brain and human behavior, mental health is often an afterthought and illnesses of the mind remain shrouded in fear and misunderstanding.”
StigmaStigma National survey data indicate that 75 percent
of the public views individuals with mental illness as dangerous. This negative view has been influenced by
negative images of psychosis, poor social skills, poor personal appearance.
Stigma is worse for schizophrenia versus depression.
National survey data indicate that 75 percent of the public views individuals with mental illness as dangerous. This negative view has been influenced by
negative images of psychosis, poor social skills, poor personal appearance.
Stigma is worse for schizophrenia versus depression.
Stigma- Mental Health CareStigma- Mental Health CarePeople with mental illness often
internalize negative attitudes toward those with mental illness, resulting in reluctance to seek and/or maintain adequate mental health care.
People with mental illness often internalize negative attitudes toward those with mental illness, resulting in reluctance to seek and/or maintain adequate mental health care.
Recovery and Project GREATRecovery and Project GREAT
““Houses” by an unnamed child from ViennaHouses” by an unnamed child from Vienna
Buzz Aldrin - AstronautBuzz Aldrin - Astronaut
…represents a convergence of data and theory and a consumer-driven movement that all clearly point to the enormous benefits of giving individuals a sense of self-determination in their own health and well-being.
…represents a convergence of data and theory and a consumer-driven movement that all clearly point to the enormous benefits of giving individuals a sense of self-determination in their own health and well-being.
The Recovery Model of mental health care
The Recovery Model The Recovery Model
Transcends the exclusive focus on symptom reduction that marks the traditional medical model.
Instills hope while emphasizing a non-linear process of recovery that includes setback and challenges.
Recognizes that people living with mental illness have strengths, goals, and dreams to be honored.
Emphasizes holistic and individualized care. Defines recovery as what the patient does.
Transcends the exclusive focus on symptom reduction that marks the traditional medical model.
Instills hope while emphasizing a non-linear process of recovery that includes setback and challenges.
Recognizes that people living with mental illness have strengths, goals, and dreams to be honored.
Emphasizes holistic and individualized care. Defines recovery as what the patient does.
The Recovery Model The Recovery Model
Insists that health care is to be Insists that health care is to be collaborative. collaborative. It is a partnership, more like midwifery It is a partnership, more like midwifery
than surgery, but perhaps characterized than surgery, but perhaps characterized best in the words of The Home Depot,best in the words of The Home Depot,
Insists that health care is to be Insists that health care is to be collaborative. collaborative. It is a partnership, more like midwifery It is a partnership, more like midwifery
than surgery, but perhaps characterized than surgery, but perhaps characterized best in the words of The Home Depot,best in the words of The Home Depot,
“You can do it. We can
help.”Used with permission of Larry Davidson, Ph.D. Davidson, L. (2007, January). Recovery and serious mental illness: What it is and how to promote it. Presentation at the Medical College of Georgia Psychiatry Grand Rounds (January 11, 2007).
The Essence of the Recovery Model of Mental Health Care
The Essence of the Recovery Model of Mental Health Care
Self-Determination
Self-Efficacy
Support
Self-Determination
Self-Efficacy
Support
Diane Arbus - PhotographerDiane Arbus - Photographer
Project G.R.E.A.T.Project G.R.E.A.T.(Georgia Recovery-Based (Georgia Recovery-Based Educational Approach to Educational Approach to
TreatmentTreatment)
Project G.R.E.A.T.Project G.R.E.A.T.(Georgia Recovery-Based (Georgia Recovery-Based Educational Approach to Educational Approach to
TreatmentTreatment) System transformation to a Recovery model
of care through teaching and dissemination.
Funded by the Georgia Department of Human Resources, Division of Mental Health, Developmental Disabilities, and Addictive Diseases with special assistance by the Carter Center in Atlanta.
System transformation to a Recovery model of care through teaching and dissemination.
Funded by the Georgia Department of Human Resources, Division of Mental Health, Developmental Disabilities, and Addictive Diseases with special assistance by the Carter Center in Atlanta.
Project G.R.E.A.T.Project G.R.E.A.T.The TeamThe Team
Project G.R.E.A.T.Project G.R.E.A.T.The TeamThe Team
Peter F. Buckley, MD Gareth Fenley, MSWP. Alex Mabe, PhD Scott A. Peebles, PhD
Peter F. Buckley, MD Gareth Fenley, MSWP. Alex Mabe, PhD Scott A. Peebles, PhD
Project G.R.E.A.T.Project G.R.E.A.T.The GoalsThe Goals
Project G.R.E.A.T.Project G.R.E.A.T.The GoalsThe Goals
To transform an academic department into a Recovery Model program.
To disseminate the Recovery Model to mental health agencies and medical schools throughout Georgia and beyond.
To transform an academic department into a Recovery Model program.
To disseminate the Recovery Model to mental health agencies and medical schools throughout Georgia and beyond.
Project G.R.E.A.T.Project G.R.E.A.T.The ChallengesThe Challenges
Project G.R.E.A.T.Project G.R.E.A.T.The ChallengesThe Challenges
“If it ain’t broke, don’t fix it” attitude. Fears that the Recovery Model would
infringe on the best practices in traditional care.
Time constraints. Stigmatizing attitudes. No administrative precedent for a
Certified Peer Specialist. No consumer presence on
hospital/clinic advisory boards.
“If it ain’t broke, don’t fix it” attitude. Fears that the Recovery Model would
infringe on the best practices in traditional care.
Time constraints. Stigmatizing attitudes. No administrative precedent for a
Certified Peer Specialist. No consumer presence on
hospital/clinic advisory boards.
Tom Harrell - Jazz MusicianTom Harrell - Jazz Musician
Project Great: Defining and Refining as we go.
Project Great: Defining and Refining as we go.
Phase I: Bringing on a Certified Peer Specialist.
Phase I: Bringing on a Certified Peer Specialist.
A “Peer Specialist” or “Peer Support Specialist”:
A “Peer Specialist” or “Peer Support Specialist”:
Manages his or her own life with mental illness
Provides mental health services to others with mental illness (peers)
Manages his or her own life with mental illness
Provides mental health services to others with mental illness (peers)
Winning against Ongoing Challenges
Winning against Ongoing Challenges
The peer specialistMay have been disabled by the most
severe diagnoses (schizophrenia, PTSD, etc.)
May also be in recovery from co-occurring substance abuse
May experience continuing symptoms of mental illness
The peer specialistMay have been disabled by the most
severe diagnoses (schizophrenia, PTSD, etc.)
May also be in recovery from co-occurring substance abuse
May experience continuing symptoms of mental illness
The Peer Specialist’s RoleThe Peer Specialist’s Role
Part of a multidisciplinary teamDoes not treat symptomsOffers role modeling and teaching
about Recovery
Part of a multidisciplinary teamDoes not treat symptomsOffers role modeling and teaching
about Recovery
The Georgia Certified Peer Specialist (CPS)
Program
The Georgia Certified Peer Specialist (CPS)
Program
High school diploma or GED required
Competitive admissions process
Two-week trainingCertification examContinuing education
High school diploma or GED required
Competitive admissions process
Two-week trainingCertification examContinuing education
Peer Support in GeorgiaPeer Support in Georgia
First ever rewarded with Medicaid reimbursement
Has trained residents of 13 US states and Canada
300+ Georgians certifiedThe leading curriculum for peer
specialist training internationally
First ever rewarded with Medicaid reimbursement
Has trained residents of 13 US states and Canada
300+ Georgians certifiedThe leading curriculum for peer
specialist training internationally
Project GREAT and the CPS Project
Project GREAT and the CPS Project
Intimately linked from the beginningHiring a CPS to join the MCG staff was
planned from the outsetSeveral CPSs collaborated to advise
MCG on a Steering Committee and in focus groups during the creation of the plan
Intimately linked from the beginningHiring a CPS to join the MCG staff was
planned from the outsetSeveral CPSs collaborated to advise
MCG on a Steering Committee and in focus groups during the creation of the plan
Institutional BarriersInstitutional Barriers Obtaining administrative clearance to hire
the CPS took a year after grant funding began
CPS credential is not recognized by MCG hospital administration
CPS is unable to view medical records or access scheduling system
CPS has hospital privileges similar to a volunteer but is full-time paid staff expected to collaborate with clinical treatment teams
Obtaining administrative clearance to hire the CPS took a year after grant funding began
CPS credential is not recognized by MCG hospital administration
CPS is unable to view medical records or access scheduling system
CPS has hospital privileges similar to a volunteer but is full-time paid staff expected to collaborate with clinical treatment teams
Opportunities and ChallengesOpportunities and Challenges Faculty, staff, and residents at all levels have
welcomed the CPS Expressed attitudes toward CPS on team
have been positive A handful of MDs have made most of the
referrals (mostly inpatients who may be difficult to follow up with as outpatients)
Many providers have expressed willingness to refer to CPS services, but puzzlement over how the process works
Faculty, staff, and residents at all levels have welcomed the CPS
Expressed attitudes toward CPS on team have been positive
A handful of MDs have made most of the referrals (mostly inpatients who may be difficult to follow up with as outpatients)
Many providers have expressed willingness to refer to CPS services, but puzzlement over how the process works
Dr. Kay Redfield Jamison- Psychologist, Scientist and Author
Dr. Kay Redfield Jamison- Psychologist, Scientist and Author
Project Great: Defining and Refining as we go.
Project Great: Defining and Refining as we go.
Phase II: Developing a Behavioral Health Advisory Council
Phase II: Developing a Behavioral Health Advisory Council
Lunatics Running The Asylum?
(Is there a place for PFCC in Mental
Health?)
Lunatics Running The Asylum?
(Is there a place for PFCC in Mental
Health?)Psychiatric patients are traditionally seen
as unable to collaborate in their own care due to mental impairment
Many family members have been encouraged to surrender care decisions entirely to professionals and even to consider some loved ones “dead”
Psychiatric patients are traditionally seen as unable to collaborate in their own care due to mental impairment
Many family members have been encouraged to surrender care decisions entirely to professionals and even to consider some loved ones “dead”
Patient and Family Advisors in Mental Health: Unique Challenges
Patient and Family Advisors in Mental Health: Unique Challenges
Physical logistics (locked units, unmarked locations)
Procedural logistics (heightened confidentiality, separate and often lesser insurance benefits)
Funding STIGMA
Affecting patientsAffecting familiesAffecting care providers
Physical logistics (locked units, unmarked locations)
Procedural logistics (heightened confidentiality, separate and often lesser insurance benefits)
Funding STIGMA
Affecting patientsAffecting familiesAffecting care providers
MCG’s Commitment
MCG’s Commitment
Vision: To be a national leader in patient and family centered teaching, research and care
PFCC inaugurated in children’s medical center MCG featured in PBS series “Remaking American
Medicine” Under leadership of VP Patricia Sodomka, FACHE,
expanding PFCC to entire MCG enterprise Top Level Departmental Leadership has attended
meeting and supported the enterprise.
Vision: To be a national leader in patient and family centered teaching, research and care
PFCC inaugurated in children’s medical center MCG featured in PBS series “Remaking American
Medicine” Under leadership of VP Patricia Sodomka, FACHE,
expanding PFCC to entire MCG enterprise Top Level Departmental Leadership has attended
meeting and supported the enterprise.
MCG’s Behavioral Health Advisory Council
MCG’s Behavioral Health Advisory Council Patient and family members referred by
clinicians Active participation by psychiatry faculty,
staff, and administrators CPS – Serves as the Facilitator Meets monthly. Minutes and policy recommendations
distributed to all members of the council and targeted faculty, staff, and administrators.
Patient and family members referred by clinicians
Active participation by psychiatry faculty, staff, and administrators
CPS – Serves as the Facilitator Meets monthly. Minutes and policy recommendations
distributed to all members of the council and targeted faculty, staff, and administrators.
Topics Tackled by the CouncilTopics Tackled by the CouncilBilling proceduresReminder calls and letters Interior decoration/renovation Involving kids in policy makingTransition to tobacco free campus Inpatient programming/volunteeringPatient and family info leafletFeedback on patient and family
experiences
Billing proceduresReminder calls and letters Interior decoration/renovation Involving kids in policy makingTransition to tobacco free campus Inpatient programming/volunteeringPatient and family info leafletFeedback on patient and family
experiences
Sigmund Freud – Psychiatrist, Scientist
Sigmund Freud – Psychiatrist, Scientist
Project Great: Defining and Refining as we go.
Project Great: Defining and Refining as we go.
Phase III: Developing workshops to immerse psychology and psychiatry faculty and students in the Recovery Model of Mental Health Care.
Phase III: Developing workshops to immerse psychology and psychiatry faculty and students in the Recovery Model of Mental Health Care.
Workshop I: Knowledge, Attitudes, and Behavior
Workshop I: Knowledge, Attitudes, and Behavior
Active learning is more effective.Expose the learner to individuals with
mental illness that promote a more positive sense of what patients can do for themselves.
Build “the case” from relevant and empirically supported data.
Provide useable tools. Teach skills, not just knowledge.
Active learning is more effective.Expose the learner to individuals with
mental illness that promote a more positive sense of what patients can do for themselves.
Build “the case” from relevant and empirically supported data.
Provide useable tools. Teach skills, not just knowledge.
Natalie Cole - SingerNatalie Cole - Singer
Jack Dreyfus – Business LeaderJack Dreyfus – Business Leader
Eleanor Roosevelt – Political LeaderEleanor Roosevelt – Political Leader
The Primacy of Choice and Personal Responsibility:
Example of Data Provided
The Primacy of Choice and Personal Responsibility:
Example of Data Provided Langer and Rodin (1976) – a field study of
nursing home residents. For one group it is stressed that their care and
well-being is the responsibility of the staff. For the other group it is stressed that they are
responsible for themselves.
Langer and Rodin (1976) – a field study of nursing home residents. For one group it is stressed that their care and
well-being is the responsibility of the staff. For the other group it is stressed that they are
responsible for themselves.
Langer & Rodin (1976) The effect of choice and enhanced personal responsibility for the aged: A field experiment in an institutional setting. J of Personality and Social Psychology, 34, 191-198.
The Effects of Choice and Enhanced Responsibility
The Effects of Choice and Enhanced Responsibility
Good care by the staff on behalf of the residents resulted in 71% becoming more debilitated.
93% of the residents given choice and responsibility increased in their functioning.
Good care by the staff on behalf of the residents resulted in 71% becoming more debilitated.
93% of the residents given choice and responsibility increased in their functioning.
Langer & Rodin (1976) The effect of choice and enhanced personal responsibility for the aged: A field experiment in an institutional setting. J of Personality and Social Psychology, 34, 191-198.
Follow-Up Rodin and Langer - 1977
Follow-Up Rodin and Langer - 1977
18 months later:
Those given choice and responsibility had a 15% mortality rate.
Those given care had a 30% mortality rate.
18 months later:
Those given choice and responsibility had a 15% mortality rate.
Those given care had a 30% mortality rate.
Rodin & Langer (1977) Long-term effects of a control-relevant intervention with the institutionalized aged. J of Personality and Social Psychology, 35, 897-902.
Georgia Recovery Assessment Form
I. Individualized and Person-Centered Treatment Plan (Goals and Objectives)Goal 1: ______________________________________________________________________________________________________________________________________________________________________________ New Patient/Family Tasks ____________________________________________________ ___________________________________________________________________________ New Provider Tasks/Responsibility____________________________________________ ___________________________________________________________________________Goal 2: ______________________________________________________________________________________________________________________________________________________________________________
New Patient/Family Tasks ____________________________________________________ ___________________________________________________________________________ New Provider Tasks/Responsibility____________________________________________ ___________________________________________________________________________Goal 3: ______________________________________________________________________________________________________________________________________________________________________________ New Patient/Family Tasks ____________________________________________________ ___________________________________________________________________________ New Provider Tasks/Responsibility____________________________________________
___________________________________________________________________________
Georgia Recovery Assessment Form - continued
II. List Personal Strengths for Patient related to personal goals:1.2.3. III. Systems-based Treatment PlanIs this individual/family appropriate for referral for Peer Support Services? (e.g., Peer Support Specialist, Friendship Community Center, AA, NA, NAMI, Parent-to-Parent, Bereaved Parents of America, Health Grandparents Project of Augusta)
YES NOWould the patient like to participate in Peer Support Services here at MCG?
YES NOWould any of the following community support areas be appropriate for consideration in your treatment planning (Please circle appropriate services): Activities/Hobbies Child Care Financial support Health Care Housing Physical fitness Occupational/job support School/Educational SupportSpiritual/religious support Substance Abuse Program Transportation
Monica Seles – Tennis ChampionMonica Seles – Tennis Champion
Workshop II: All about Attitudes
Workshop II: All about Attitudes
Focused on reversing negative stereotypes regarding those individual living with mental illness.
Provided “real examples” of individuals “in recovery.”
Emphasized the stories and less so the principles. Hearing first hand from providers who have
transformed their practice to the Recovery Model.
Focused on reversing negative stereotypes regarding those individual living with mental illness.
Provided “real examples” of individuals “in recovery.”
Emphasized the stories and less so the principles. Hearing first hand from providers who have
transformed their practice to the Recovery Model.
Workshop II clipsWorkshop II clips
Ray Charles - MusicianRay Charles - Musician
Project Great: Defining and Refining as we go.
Project Great: Defining and Refining as we go.
Phase IV: Putting the Recovery Model into Practice.
Phase IV: Putting the Recovery Model into Practice.
Follow-Up Implementation of the Georgia Recovery Assessment Form
Follow-Up Implementation of the Georgia Recovery Assessment Form
Working with PowerNote technical support to make sure that all psychiatry clinical notes have prompts to complete the three key Recovery-Based questions.
Working with PowerNote technical support to make sure that all psychiatry clinical notes have prompts to complete the three key Recovery-Based questions.
Putting into Practice - MorePutting into Practice - More Putting the Certified Peer Specialist into the
game. Keeping the fire under the Behavioral Health
Advisory Council. Data Collection. Relaunching the GREAT Steering Committee.
Putting the Certified Peer Specialist into the game.
Keeping the fire under the Behavioral Health Advisory Council.
Data Collection. Relaunching the GREAT Steering Committee.
Preliminary Findings Preliminary Findings
Workshop I – Knowledge of Recovery significantly improved.
Workshop II – Attitudes regarding the capabilities of those with mental illness to actively participate in their care significantly improved.
Workshop I – Knowledge of Recovery significantly improved.
Workshop II – Attitudes regarding the capabilities of those with mental illness to actively participate in their care significantly improved.
“Lot Easier Said than Done”“Lot Easier Said than Done”
Where are the referrals for the Certified Peer Specialist?
Logistics of incorporating a Certified Peer Specialist into a traditional academic department.
Getting administration to listen to the Behavioral Health Advisory Council recommendations.
Changing practice habits is hard!
Where are the referrals for the Certified Peer Specialist?
Logistics of incorporating a Certified Peer Specialist into a traditional academic department.
Getting administration to listen to the Behavioral Health Advisory Council recommendations.
Changing practice habits is hard!
Next StepsNext Steps More data collection, including comparison
academic site. Do a consumer needs assessment. Specific
data need to move beyond contemplation of change.
Identify Recovery Champions among our faculty and residents.
Establish participative decision-making: Establish faculty and resident focus groups.
More data collection, including comparison academic site.
Do a consumer needs assessment. Specific data need to move beyond contemplation of change.
Identify Recovery Champions among our faculty and residents.
Establish participative decision-making: Establish faculty and resident focus groups.
Dr. Patricia Deegan and Associates- Clinical Psychologist, Author, and Co-Founder
of the National Empowerment Center Inc.
Dr. Patricia Deegan and Associates- Clinical Psychologist, Author, and Co-Founder
of the National Empowerment Center Inc.
