Choosing Hope
Recovery, Self-Determination,
and Peer Support
Paolo del Vecchio, MSW
Acting Director, Center for Mental Health Services
Substance Abuse and Mental Health Services Administration
VOCAL Annual Statewide Peer Conference
Harrisonburg, VA ♦ May 21, 2012
Self-Determination
Self-determination helps
people, their families, and
friends determine their
future; design their own
support plans; choose the
assistance they need to live
full lives; and control a
personal budget for their
supports.
CT Department of Developmental
Services
Fire Walking
Helping people heal one step at a time
My Story
Choosing Hope
“The purpose of life, after all, is to live it, to taste experience to the
utmost, to reach out eagerly and without fear for newer
and richer experiences.”
– Eleanor Roosevelt
Time for Change
Recovery Emerges From Hope
“Hope is to the soul what oxygen is to the
body.” – Larry Fricks
Defining Recovery
A process of change
through which
individuals improve their
health and wellness, live
a self-directed life, and
strive to reach their full
potential.
– SAMHSA, 2011
Four Dimensions of Recovery
Individuals
and Families
Social Exclusion
“By any measure, it is clear
that people with mental
illnesses are on the margin,
actually not on the page at
all. Dying decades earlier
than the general population
is testament enough about
how those with mental
illnesses have been
marginalized.”
– Paolo del Vecchio
SAMHSA’s Pledge for Wellness
“We envision a future in
which people with mental
health problems pursue
optimal health, happiness,
recovery, and a full and
satisfying life in the
community via access to a
range of effective services,
supports, and resources.”
Eight Dimensions of Wellness
– Adapted from Swarbrick, M. (2006). A wellness approach. Psychiatric
Rehabilitation Journal, 29,(4) 311- 314.
Psychiatric Advance Directives
Psychiatric advance directives:
• Empower consumers to assume control over treatment
decisions
• Enhance communications about treatment preferences
among consumers, their families, and treatment providers
• Facilitate appropriate and timely treatment interventions
before situations deteriorate to emergency status
• May lead to reductions in adversarial court proceedings over
involuntary psychiatric treatment
– Ronald S. Honberg, National Director for Policy and Legal Affairs, NAMI
Home
Purpose
Contribution – Independence – Hope
Community
“Those of us who have
experienced psychiatric
symptoms are (…) climbing
mountains, planting
gardens, painting pictures,
writing books, making quilts,
and creating positive change
in the world.”
– Shery Mead, MSW, and Mary Ellen Copeland MS, MA
Shared Decision Making
The new SDM site offers a print/video link, online decision aid, workbooks,
and cool tools: http://www.samhsa.gov/consumersurvivor/sdm/StartHere.html
Importance of Choice
Common Antipsychotic Side Effects:
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Abnormal movements
Diabetes
Dry mouth
Metabolic syndrome
Neuroleptic malignant syndrome (NMS)
Sexual side effects
Sleep problems
Stroke
Sudden cardiac death
Weight gain
Medication Best Practices
• Shared Decision-Making: Provide individuals with to up-to-date information
about the drugs they take, including potential side effects.
• Individualized, Person-Centered Care: View medication use as a dynamic
process that evolves over each person’s unique recovery journey.
• Holistic Approach: Adopt a bio-psycho-social-cultural-spiritual model to
assess benefits and costs of using medications as a tool for recovery.
• Relational: Prescribe and monitor medications within the context of a
trusting and collaborative relationship.
• Integrated Treatment: Prescribe and monitor medications within an
integrated community-based recovery plan.
• Need for Protocols: Use medication “if needed, as needed, and as seldom as
possible” and in combination with psychological and social supports.
Self-Directed Care
Nerney, T. (2001). Self-determination:
understanding the core principles deeded
for people with disabilities to control their
own lives. Augustine: Training Resource
Network, Inc.
Self-determination is based on five
principles:
• Freedom – to live in the community
• Authority – over funds needed for selfcare
• Support – to make choices
• Responsibility – to manage finances,
choose services, and handle tasks of
daily living
• Confirmation or Participation – the
opportunity to participate in decision
making about the care delivery system
.
Self-Directed Care in Mental Health
Adults with mental illnesses that participate in self-directed care
have:
• Higher satisfaction with their quality of life;
• Higher satisfaction with their paid caregivers;
• Fewer unmet needs;
• No more injuries or other adverse health outcomes than other
individuals;
• No significant differences in total expenditures;
• The ability to successfully manage the cash option.
SAMHSA. (2010). Self-directed care in mental health: Lessons from the Cash &
Counseling Demonstration Evaluation.
Constituent-Identified SAMHSA
Accomplishments
SAMHSA accomplishments identified by constituents include:
• Peer programs that promote complete mental health recovery
• Focus on the recovery model and consumer driven care
• Realization that forced drugging is a human rights abuse
• Implementation of assisted outpatient treatment
• Recovery learning communities
• Crisis intervention teams for law enforcement
• Trauma-informed care
• Court ordered outpatient treatment
• Peer support
• Supported housing for the seriously mentally ill
Peer Support
“Peer specialists
bring the essential
message of hope
that acts as a
catalyst for people
to begin their
journey of recovery.”
– Paolo del Vecchio
– Visions of Hope Arizona
Peer Workforce Issues
Challenges:
• Financing of peer specialists
• Misperceptions or lack of staff knowledge
• Over-assimilate and take on roles of
traditional mental health providers
• Inappropriate work roles with no
opportunity for advancement
Solutions:
• Trust-based relationships
• Clearly defined, formal job description
• Ongoing skills-based training and
certification
• Same performance expectations as other
employees
SAMHSA ADS Center
• Teleconferences:
– Peer Respite Services: Transforming Crisis
to Wellness
– Peer Support and Peer Providers:
Redefining Mental Health Recovery
• Information Update, “Promising Practices
for Social Inclusion: Peer-Provided Respite
Care—Innovative Practices that Promote
Wellness and Recovery”
• ADS Center’s My Story section
• SAMHSA Consumer-Operated EvidenceBased Practice Kit
• Nuts and Bolts: A Technical Assistance
Guide for Mental Health
Consumer/Survivor Self-Help Groups
SAMHSA’s Resource Center to Promote
Acceptance,
Dignity and Social Inclusion Associated with
Mental Health (ADS Center)
Announcing the
SAMHSA Million Hearts Social Marketing Programs for Peer-Run/Recovery
Community Organizations
http://promoteacceptance.samhsa.gov/CSI/awards/
default.aspx
SAMHSA Peer Support and ConsumerOperated Activities
“Peer recovery coaches go where
no other group goes.” – Joe Powell,
Executive Director, Association of Persons Affected by
Addictions
SAMHSA funds and supports the following
initiatives, among others:
• Peer-Run and Recovery Community
Organizations
• Expert Panel Meeting on Peer
Specialists and Peer Recovery Coaches
• Pillars of Peer Support Services Summit
• Statewide Consumer and Family
Network Grants
• National Consumer and Consumer
Supporter Technical Assistance Centers
• Annual Consumer Conference –
Alternatives Conference
Closing Thoughts
“The choice is ours to make.”
For More Information
SAMHSA
1 Choke Cherry Road • Rockville, MD • 20857
Phone: 1-877-SAMHSA-7 (1-877-726-4727)
TTY: 1-800-487-4889
Fax: 240-221-4292
http://www.samhsa.gov
CMHS
Phone: 240-276-1310
Fax: 240-276-1320
Questions & Answers