Carol Skinner BA, RCAT Karen White-Jones BA September 21, 2010

1. Canadian Mental Health Association Ottawa Branch: Integrated Treatment for Individuals with Co-occurring Mental Health and Substance Use Disorders Art Therapy Program Carol Skinner BA, RCAT Karen White-Jones BA September 21, 2010

2. Why is CMHA in the business of addressing concurrent disorders? Approximately 50% of persons with severe mental illnesses will develop alcohol or other drug use disorders at some point in their lives. Small amounts of substance use have a severe impact on mental health.

3. Impact of Substance Abuse on Psychiatric Illness Effects are additive………. • Relapse and re-hospitalizations • In severity of depression symptoms related to alcohol consumption • Family / interpersonal conflict • Financial problems • Risk of violence / aggression (perpetrator and/or victim)  Risk of homelessness / housing problems  Legal problems  Risk of severe physical health problems • Suicide risk All of these effects add up to Early Mortality

4. Integrated Treatment as a Key Component – what it looks like Integrated treatment is found in a program or between programs in which a clinician or clinicians assume the responsibility of integrating the treatments so that interventions are selected, modified, combined, and tailoredfor each specific client. In all interventions, both mental illness and addictions are taken into consideration and considered primary. (adapted from Mueser, pg. 20)

5. Integrated Treatment as a Key Component – what it looks like In addition, the following elements are present: • shared decision making • comprehensiveness of approach • assertiveness • harm reduction • a long-term perspective • motivational, stage-wise interventions

6. Concurrent Disorder Group Treatment Program • Total of 199+ clients participate in 22 weekly group sessions • Communication and collaboration between client, group facilitators (including facilitators from partner agencies), community support worker • All groups are open-ended, many are population specific, and most are operated on site at CMHA (1 at ROH, 1 at SCUW (ICH), 1 at SCUM, 1 at YSB) • Groups are generally 1 ½ hours, with an average of 5-6 members attending

7. Levels of Treatment within the CD Program matched to Stages of Change

8. Art Therapy Concurrent Disorder Groups • Women’s Engagement/Persuasion • Young Women’s Persuasion • Men’s Active Treatment • Women’s Active Treatment • Women’s Relapse Prevention

9. Art Therapy The language of visual art-colors, shapes, lines, and images-speaks to us in ways that words cannot. Art therapy is a modality that uses the nonverbal language of art for personal growth, insight, and transformation and is a means of connecting what is inside us-our thoughts, feelings, and perceptions-with outer realities and life experiences. It is based on the belief that images can help us understand who we are and enhance life through self-expression. -Cathy Malchiodi, ATR

10. Art TherapyProcess vs Product Process of creating art: • Inherent healing power in the production of art • Express oneself creatively • Sensory experience can be stress relieving • Release of emotions cathartic, provides relief Final imagery in the art therapy product: • Symbolic communication • Therapist helps client to find meaning in their artwork • Facilitates client insight which can lead to positive changes and growth • Tangible product

11. Goals for Art Therapy Groups • Have a safe place to discuss substance use, mental illness, emotions • To listen to others and provide and receive supportive and non-judgmental feedback • Feel a sense of accomplishment and pride in creation of art • Opportunity to play, laugh, and to express oneself creatively • Lessen isolation through social interaction • Focus on a task • Use art as a self-soothing mechanism • Build on the therapeutic alliance • Opportunity to practice healthy risk-taking and learn how to trust others • Participation in psychoeducation • Develop growth in coping skills

12. Women’s Engagement/Persuasion Art Therapy Groups Client profile: • Marginalized women in turmoil • Sex Work • Abuse, Trauma (History & Current) • In and out of custody • Homeless or at risk of losing housing • Schizophrenia, Mood Disorders, Personality Disorders • HIV, Hep C • Heavy users; crack, cocaine, IV use, opiates • Sporadic group attendance

13. Key Elements of Engagement /Persuasion Art Therapy Groups • As art therapy is a dynamic process, clients are participating in their own treatment, through creation of art • An accepting group environment where clients are free to discuss their experiences without fear of judgment, confrontation or social censure • Mix of spontaneous and theme directed art, women express feelings that are too difficult to put into words through their art • Facilitators encourage clients to make links between their daily experiences and their drug/alcohol use while promoting strengths and finding hope

24. Alphabet poetry

33. Women’s Active Treatment Art Therapy Group Client profile: History of sexual, physical, emotional trauma Most housed with subsidized apartment and/or group home Considerable reduction in use or abstinence As use decreases, emotions & memories surface Clients have developed an awareness of the negative effects of substance use on their lives Mental illness managed with medication Many grieving losses associated with substance use and mental illness 33

34. Key Elements of Women’s Active Treatment Art Therapy Groups Mostly art directive themes and psycho education used to explore the following: • Developing new skills for dealing with triggers and managing cravings • Expressing and coping with difficult feelings • Uncovering and examining core issues such as trauma • Dealing with relapses and developing a relapse prevention plan • Safety plans to manage all self-harming behaviours • Discovering and exploring client’s core values and examining behaviours in conflict with those values • An understanding of the connection between history to present behaviour

35. Group Structure • Two-Hour Group • Grounding & Visualization • Check-In (including facilitators) • Break • Psychoeducation • Art Directive • Check-Out; processing & discussion of artwork created