Alan Doyle EdD
John Rivera
Ralph Aquila MD
NAMI Conference
Washington DC
September 4, 2014
Son:
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car accident-ran into tree
withdraws from college
cannot hold jobs
drops out of technical programs
works for family
enters drug rehab
Family:
◦ embarrassed
◦ cannot stay at home anymore
◦ lacks resources
HELP?
HOPE?
place
•
•
•
idea
hope for families and friends
•
recovery
•
social integration
•
personal meaning
vision:
• world wide replications (300s+)
model:
• working community
• evidence-based practice
Condition
• denial of illness
• no motivation
• loss of relationships
Do I make a difference in life?
Programs
• sense of being without anyone who can help
Stigma
• considered dangerous
Drag on national economy
Purpose
 give meaning
Roles and Responsibilities
(structured relationships)
 enactive experience
 modeling
 social persuasion
Planning
 shared leadership/empowerment
Learning
 feedback/thank you
intentionally developed
need to be needed
choice
collaborative roles( side-by-side)
integrated treatment:
 employment
 schooling
 psychiatric
 social
 general health
The Clubhouse and Psychiatry Twenty two years of partnership
Ralph Aquila M.D.
John Rivera
Alan Doyle Ph.D
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Historically, treatment for mental illness focuses on
elimination of positive symptoms (i.e. hallucinations,
delusions, disordered speech, etc) and side effects
Little attention was paid to medical co-morbidity
Prevents focus on rehabilitation, life goals;
encourages noncompliance
Disparity between severity of patient’s illness and
physician’s level of training
What is the Rehabilitation
Alliance?
 Network of relationships between patient, psychiatrist, and a third person:
family member, friend, clinician, staff worker, etc.
 Alliance focuses on strengths and life goals, with all participants acting as
co-equals
 Third member can provide information about patient’s performance in
other areas of his/her life
 Goal becomes not only elimination of symptoms but also reintroduction
into society
The Alliance in Practice
 Rehabilitation Alliance was implemented in 1992 through partnership
between Fountain House and St. Luke’s-Roosevelt Hospital Center
 Psychiatric and Primary Care services provided at the Sidney R. Baer Jr.
Center near to Fountain House
 Convenient, non-institutional setting makes the Storefront accessible to
Fountain House members, providing anonymity and protecting users
from stigma
Primary Care
 2000, Primary Care Physician joins clinic
 Working side by side, Psychiatrist, PC, and
Fountain House Staff
 Time, key factor in helping members get the
services they need
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Prevalence is 3 to 4 times the general
population
Access is much worse
Insight limits access
“Fountain House has been on the leading edge of offering
integrated care to New Yorkers with complex needs for
more than a decade. With this new expansion of the
Sidney Baer Center, Fountain House members will have
increased access to critical, high-quality care that
addresses the full spectrum of their needs.”
Nirav Shah, New York State Health Commissioner.