;
Download
1 / 64

Project GREAT: Bringing Consumerism to Mental Health Education and Services Department of Psychiatry and Health Behavio - PowerPoint PPT Presentation


  • 190 Views
  • Uploaded on

; . Project GREAT: Bringing Consumerism to Mental Health Education and Services Department of Psychiatry and Health Behavior Medical College of Georgia, Augusta, GA. Gareth Fenley, MSW Certified Peer Specialist Alex Mabe, PhD Professor and Chief of Psychology

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Project GREAT: Bringing Consumerism to Mental Health Education and Services Department of Psychiatry and Health Behavio' - russ


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Slide1 l.jpg

;

Project GREAT: Bringing Consumerism to Mental Health Education and ServicesDepartment 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


The mental health delivery system is fragmented and in disarray l.jpg

“…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 l.jpg

Mental Illness Affects People in the Prime of Their Lives disarray.”

Half of the lifetime cases of mental illness begin by age 15 and three-quarters by age 24


Slide4 l.jpg

About half of Americans will meet criteria for a DSM-IV Disorder in their lifetime.

Kessler, et al., 2005


Use of mental health services adults l.jpg

Use of Mental Health Services- Adults Disorder in their lifetime.

Between 2001 and 2003,

60 percent of individuals with a mental disorder got no treatment

National Comorbidty Survey Replication Study- Wang et al., 2005


Use of mental health services serious mental illness l.jpg

Use of Mental Health Services- Disorder in their lifetime.Serious Mental Illness

  • 55 percent stated that they had not received services because they did not need it.

National Comorbidty Survey Study- Kessler et al., 2001


Use of mental health services l.jpg

Use of Mental Health Services Disorder in their lifetime.

  • 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

National Comorbidty Survey Study- Edlund et al., 2002


Medication regimen adherence l.jpg

Medication Regimen Adherence Disorder in their lifetime.

  • Noncompliance rates well over 50% for most medication treatments of major psychiatric disorders – often not detected by the provider.


Slide9 l.jpg

Access to High Quality Care Disorder in their lifetime.

In 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 l.jpg

Have Psychiatrists Become Medication Managers? Disorder in their lifetime.

From 1987 to 1997:

  • Percent of patients receiving medications doubled.

  • Average number of visits declined from 12.6 to 8.7.

Olfson et al., 2002


Traditional psychiatric care l.jpg

Traditional Psychiatric Care Disorder in their lifetime.

Case Vignette


Stigma l.jpg
Stigma Disorder in their lifetime.

  • 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.”


Stigma13 l.jpg
Stigma Disorder in their lifetime.

  • 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 care l.jpg
Stigma- Mental Health Care Disorder in their lifetime.

  • 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 great l.jpg
Recovery and Project GREAT Disorder in their lifetime.

“Houses” by an unnamed child from Vienna


Buzz aldrin astronaut l.jpg
Buzz Aldrin - Astronaut Disorder in their lifetime.


Slide17 l.jpg

…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 l.jpg
The Recovery Model consumer-driven movement that all clearly point to the enormous benefits of giving individuals a sense of

  • 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 model19 l.jpg
The Recovery Model consumer-driven movement that all clearly point to the enormous benefits of giving individuals a sense of

  • Insists that health care is to be collaborative.

    • It is a partnership, more like midwifery than surgery, but perhaps characterized 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 l.jpg
The Essence of the Recovery Model of Mental Health Care consumer-driven movement that all clearly point to the enormous benefits of giving individuals a sense of

  • Self-Determination

  • Self-Efficacy

  • Support


Diane arbus photographer l.jpg
Diane Arbus - Photographer consumer-driven movement that all clearly point to the enormous benefits of giving individuals a sense of


Project g r e a t georgia recovery based educational approach to treatment l.jpg
Project G.R.E.A.T. consumer-driven movement that all clearly point to the enormous benefits of giving individuals a sense of (Georgia Recovery-Based Educational Approach to Treatment)

  • 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 the team l.jpg
Project G.R.E.A.T. consumer-driven movement that all clearly point to the enormous benefits of giving individuals a sense of The Team

  • Peter F. Buckley, MD

  • Gareth Fenley, MSW

  • P. Alex Mabe, PhD

  • Scott A. Peebles, PhD


Project g r e a t the goals l.jpg
Project G.R.E.A.T. consumer-driven movement that all clearly point to the enormous benefits of giving individuals a sense of The 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.


Project g r e a t the challenges l.jpg
Project G.R.E.A.T. consumer-driven movement that all clearly point to the enormous benefits of giving individuals a sense of The 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.


Tom harrell jazz musician l.jpg
Tom Harrell - consumer-driven movement that all clearly point to the enormous benefits of giving individuals a sense of Jazz Musician


Project great defining and refining as we go l.jpg
Project Great: consumer-driven movement that all clearly point to the enormous benefits of giving individuals a sense of Defining and Refining as we go.

  • Phase I: Bringing on a Certified Peer Specialist.


A peer specialist or peer support specialist l.jpg
A “Peer Specialist” consumer-driven movement that all clearly point to the enormous benefits of giving individuals a sense of or “Peer Support Specialist”:

  • Manages his or her own life with mental illness

  • Provides mental health services to others with mental illness (peers)


Winning against ongoing challenges l.jpg
Winning against Ongoing Challenges consumer-driven movement that all clearly point to the enormous benefits of giving individuals a sense of

  • The peer specialist

    • May 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 role l.jpg
The Peer Specialist’s Role consumer-driven movement that all clearly point to the enormous benefits of giving individuals a sense of

  • Part of a multidisciplinary team

  • Does not treat symptoms

  • Offers role modeling and teaching about Recovery


The georgia certified peer specialist cps program l.jpg
The Georgia Certified Peer Specialist (CPS) Program consumer-driven movement that all clearly point to the enormous benefits of giving individuals a sense of

  • High school diploma or GED required

  • Competitive admissions process

  • Two-week training

  • Certification exam

  • Continuing education


Peer support in georgia l.jpg
Peer Support in Georgia consumer-driven movement that all clearly point to the enormous benefits of giving individuals a sense of

  • First ever rewarded with Medicaid reimbursement

  • Has trained residents of 13 US states and Canada

  • 300+ Georgians certified

  • The leading curriculum for peer specialist training internationally


Project great and the cps project l.jpg
Project GREAT consumer-driven movement that all clearly point to the enormous benefits of giving individuals a sense of and the CPS Project

  • Intimately linked from the beginning

  • Hiring a CPS to join the MCG staff was planned from the outset

  • Several CPSs collaborated to advise MCG on a Steering Committee and in focus groups during the creation of the plan


Institutional barriers l.jpg
Institutional Barriers consumer-driven movement that all clearly point to the enormous benefits of giving individuals a sense of

  • 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 challenges l.jpg
Opportunities and Challenges consumer-driven movement that all clearly point to the enormous benefits of giving individuals a sense of

  • 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 l.jpg
Dr. Kay Redfield Jamison- Psychologist, Scientist and Author consumer-driven movement that all clearly point to the enormous benefits of giving individuals a sense of


Project great defining and refining as we go37 l.jpg
Project Great: consumer-driven movement that all clearly point to the enormous benefits of giving individuals a sense of Defining and Refining as we go.

  • Phase II: Developing a Behavioral Health Advisory Council


Lunatics running the asylum is there a place for pfcc in mental health l.jpg
Lunatics Running The Asylum? consumer-driven movement that all clearly point to the enormous benefits of giving individuals a sense of (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”


Patient and family advisors in mental health unique challenges l.jpg
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 patients

    • Affecting families

    • Affecting care providers


Mcg s commitment l.jpg
MCG’s Commitment Challenges

  • 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 l.jpg
MCG’s ChallengesBehavioral 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.


Topics tackled by the council l.jpg
Topics Tackled by the Council Challenges

  • Billing procedures

  • Reminder calls and letters

  • Interior decoration/renovation

  • Involving kids in policy making

  • Transition to tobacco free campus

  • Inpatient programming/volunteering

  • Patient and family info leaflet

  • Feedback on patient and family experiences



Project great defining and refining as we go44 l.jpg
Project Great: ChallengesDefining 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.


Workshop i knowledge attitudes and behavior l.jpg
Workshop I: ChallengesKnowledge, 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.





The primacy of choice and personal responsibility example of data provided l.jpg
The Primacy of Choice and ChallengesPersonal 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 & 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 l.jpg
The Effects of Choice and Enhanced Responsibility Challenges

  • 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 l.jpg
Follow-Up ChallengesRodin and Langer - 1977

  • 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.


Slide52 l.jpg

Georgia Recovery Assessment Form Challenges

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____________________________________________

___________________________________________________________________________


Slide53 l.jpg

Georgia Recovery Assessment Form - continued Challenges

II. List Personal Strengths for Patient related to personal goals:

1.

2.

3.

III. Systems-based Treatment Plan

Is 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 NO

Would the patient like to participate in Peer Support Services here at MCG?

YES NO

Would 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 Support

Spiritual/religious support Substance Abuse Program Transportation



Workshop ii all about attitudes l.jpg
Workshop II: ChallengesAll 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.


Workshop ii clips l.jpg
Workshop II clips Challenges



Project great defining and refining as we go58 l.jpg
Project Great: ChallengesDefining and Refining as we go.

  • Phase IV: Putting the Recovery Model into Practice.


Follow up implementation of the georgia recovery assessment form l.jpg
Follow-Up Implementation of the ChallengesGeorgia 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.


Putting into practice more l.jpg
Putting into Practice - ChallengesMore

  • 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 l.jpg
Preliminary Findings Challenges

  • 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 l.jpg
“Lot Easier Said than Done” Challenges

  • 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 steps l.jpg
Next Steps Challenges

  • 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.


Slide64 l.jpg
Dr. Patricia Deegan and Associates- ChallengesClinical Psychologist, Author, and Co-Founder of the National Empowerment Center Inc.


ad