How Can Community Psychiatry Facilitate Recovery?

1. How Can Community Psychiatry Facilitate Recovery? Mark Salzer, Ph.D., Director UPENN Collaborative on Community Integration: The RRTC Promoting Community Integration of Individuals with Psychiatric Disabilities

2. Recovery is the process of pursuing a fulfilling and contributing life regardless of the difficulties one has faced.  It involves not only the restoration but continued enhancement of a positive identity and personally meaningful connections and roles in one's community.   Recovery is facilitated by relationships and environments that provide hope, empowerment, choices and opportunities that promote people reaching their full potential as individuals and community members.   Definitions of Recovery (Philadelphia DBH/MRS, 2006)

3. More people in the community (PA Data) # of Individuals in Pennsylvania State Hospitals at end of fiscal year

4. Stigma and Discrimination Persists Housing Education Employment Financial independence Blocked rights Limited social roles Atrophied leisure/recreation Limited attention to spiritual issues Limited encouragement to vote Limited self-determination …but NOT OF the Community

5. Modest Residential Segregation: Poverty a Major Barrier From Metraux, Caplan, Klugman, Hadley (in press)

6. Many people are parents (e.g., National Comorbidity Study data) 68% of women with a psychiatric disability are mothers vs. 62.4% of general population 54.5% of men with a psychiatric disability vs. 52.9% of men in general population But more likely to lose custody 70-80% of women who are hospitalized have experienced custody loss Mothers with a psychiatric diagnosis are 4X more likely to lose custody (Park and Mandell, in press) Social Roles

7. Americans with Disabilities Act (1990) Supreme Court Olmstead decision (1999): unnecessary institutionalization is a form of discrimination prohibited by the ADA President’s New freedom Initiative (2001) Community Integration Legal and Policy Grounding

8. Housing Employment Education Health Status Leisure/Recreation Spirituality Citizenship and civic engagement Valued Social Roles (e.g., marriage, parenting) Peer Support Self-Determination Community Integration Definition • The opportunity to live in the community, and be valued for one’s uniqueness and abilities, like everyone else (Salzer & Baron, 2005)

9. Community Integration Drives Participation and Facilitates Recovery (Salzer & Baron, 2005) Community Integration Outcomes Community Presence and Participation Community Integration (Opportunity) Well-Being and Recovery

10. Paradigm shift in views about disability Old paradigm: “Disability” is something inherent within an individual New paradigm: “Disability” results from a person-environment interaction that reduces opportunities for people to live like everyone else Reduce “disability” and increase opportunity by Reducing and eliminating environmental barriers Making individualized supports readily available Opportunities need to be promoted in all life domains Community Integration Principles

11. Community Integration Practice: Roadmap to Recovery

12. Question to be answered:  How can community psychiatrists facilitate recovery in policy, programs, and practice? Breakout Groups

13. Go through each domain (housing, employment, education, social roles, peer support,citizenship, leisure/recreation, spirituality, self-determination) and answer the following questions: 1) What issues limit opportunities for people to live satisfying and fulfilling lives in this domain at the (policy or program) level? 2) What initiatives can be taken to address these issues at the (policy or program) level? Policy and Program Groups

14. How can hope be promoted in treatment? How can self-determination be facilitated in treatment? How can opportunity in the various life domains (e.g., housing, employment, education, social roles, peersupport, citizenship, leisure/recreation, spirituality) be promoted in treatment? Practice group