6/27/2014 Creating Community in Mental Health Practice Julius Lanoil Quotes • 1)"The way out of madness is: To do useful things to contribute to the environment." (Wilson Van Dusen ) • 2) "We are all longing to go home to some place we have never been — a place, half-remembered, and half- envisioned, we can only catch glimpses of from time to time. Community. Somewhere, there are people to whom we can speak without having the words catch in our throats. Somewhere a circle of hands will open to receive us, eyes will light up as we enter, voices will celebrate with us whenever we come into our own power. Community means strength that joins our strength to do the work that needs to be done. Arms to hold us when we falter. A circle of healing. A circle of friends. Someplace where we can be free." "The importance of belonging" by David Pitonyak • 3) More than the hunger, the cold and the confusing things you see and feel, is the pain of not being needed by a single soul." ( A homeless mentally ill person) Julius Lanoil - About me 1
6/27/2014 The Four Pillars of FH Community FH an intentional community which has been replicated in hundreds of times in the US and around the world 1) Choice • Choose their Coach and the Activities they wish to be part of • Opportunities in Ed group, Wellness group Research group, Farm group at Highpoint, culinary group, intake group, RO group, clerical group, tutoring group • Housing, employment, TE individual and group, social Entreprises, supported employment, employment counseling, education of staff from other communities around the world program. College reentry, Evening weekend holiday recreation 2) The Staff as social practitioners and generalists • Relate to members needs as a total person, each staff responsible for – 1)An activity area – 2) some amount of housing – 3) some number of employment placement in TE – 4) evening program recreation – 5) reaching out ( if isolating ) 2
6/27/2014 3) Members are needed to help (Who needs the people with serious mental illness) - FH does The FH structure is such that staff need members to help. – Being needed celebrates a persons humanity – Confers dignity – Increases self-esteem – Increases the motivation to participate – Controls staffs arbitrary behavior and the members sense of helplessness • Increases learning capacity (Vygotskies theory of learning). (Note 8) There are seven rules to helping someone feel needed: • First there must be the perception that something worthwhile needs to be done • Second that worthwhile something that needs to be done must be in a worthwhile context. • Third the person being asked for the help must have the sense that they are necessary to do the task. • Forth the person being asked for help must feel that they have the competence to do the task. • Fifth, the leader asking for the help must offer the tools and or support that insures that persons sense of competence. • Sixth, the leader must feel that the completion of the task will make a difference • Seventh, after the work is completed, appreciation 4) XXXX Fighting Infanitilization 3
6/27/2014 The Initial Goals • Have the members feel they belong to the FH community • Opportunity to help themselves and others • Feeling part of a dependable and stable structure’ • As discussed Feeling that that they are needed and are relevant • Belief that through membership their needs will be met • Develop a shared emotional connection • In addition to belonging and feeling needed Have the opportunity to do productive and necessary things at FH and in the general community - Members have many opportunities to form relationship (relationship deficit and mental illness, - Have a significant relationship with a staff coach - See the opportunities at FH that relate to their interests or passions - Have their basic needs Primary issue that limits successful treatment • FH The Primary Issue in Accomplishing the Goals is lack of Motivation – the primary negative symptom of serious mental illness. A Lack of Motivation 4
6/27/2014 • Positive symptoms are those most associated with mental illness • Negative symptoms are behaviors, thoughts or feelings normally present that are absent in people with mental illness motivation and lack of motivation affect lack of affect cognition lack of some aspects of cognition • Secondary negative symptoms are the result of the illness such as low self esteem and self efficacy and stigma, poverty, poor health. Lack of motivation • Has a major affect on cognitive dysfunctions • Is the negative symptom that inhibits functional recovery • Is the core negative symptom of schizophrenia and that all of the other negative symptoms should be subsumed in this category When people regain their lost motivation their cognitive functioning also improves. Cognitive functioning improvements require an environment in which learning and improvements in self efficacy abound (S.M. Silverstein). The process of Motivating Treatment Elements at F.H 5
6/27/2014 Increasing self efficacy using the “side by side” process. Staff as transformational leaders • Progressive task and interpersonal successes which improves self esteem and confidence – increases in motivation to try new things. • Reduces defeatist beliefs based on past failures • Bandura – real vs. simulated activity Bandura- self efficacy through mastery, vicarious experience and verbal persuasion Deci and Ryans- Self determination theory for intrinsic motivation and self actualization autonomy – choice, relatedness, relationships, competence- increasing self efficacy Developing a significant relationship • Staff functioning as motivational coaches • Frank & Frank – “it’s the relationship” • Can do for others, not self: people or community they care about • Theorem of successful risk taking The Overall Process of Motivating members is governed by • A strength based approach (Seligman quote)"Strengthening Strengths will weaken weaknesses" • "Using your signature strengths is concordant with your intrinsic interests and values; hence in a supportive environmental context the clients strengths will become evident. This does not typically happen in a prescriptive way such as having the client complete a strengths inventory, but it occurs spontaneously in the relationship." 6
6/27/2014 • Providing positive experiences – Negative and positive experiences are formative – Positive experiences are formative and curative – The primary positive experiences are • Being needed: Being Needed Everybody has a need to be needed, to feel relevant and necessary in the world. Regardless of age or life-limiting problems that need to be needed doesn't suddenly cease to exist. It has an energy force attached to it which will either find satisfaction through positive expression or if blocked, the energy attached to it will be repressed. (Chock full of nuts and thrift shop story) • Experiencing success • Having choice • Having control and making decisions • The opportunity to form relationships • A normal life pattern • Satisfying basic needs Staff Role as Motivational Coach • The Motivational Coach Role (our version of case management) • Establishing a significant relationship • What is it? – Influential capacity (the ability to help others reassess beliefs and behaviorist- the likelihood that feedback will be heard and evaluated) – Mutuality (both parties allow each other into their lives and comfortable sharing “some” emotional and factual aspects of who they are – Authenticity – realness without professional façade – A focus on current strengths – Not Freudian transference – Respectful and trusting – Collaborative – Involves all domains of life – Becomes special to the members – Intense, yet with appreciation for member choice • It comes about when there is: – Basic acceptance – R.O. to start the conversation – Removal of obstacles to participation – Completing of the helping act – Giving realistic, honest, sensitive feedback (Cleaning glass story – Getting an initial “yes” (a “no” at this point can be destructive to the relationship) – Finding common interests – Active RO for problems (Isolation story) – A belief in the members future (hopefulness) – Sharing membership in the FH community – Providing leadership, charisma and enthusiasm 7
6/27/2014 • When Does It Develop? – Staff see a challenge – Staff finds something to like and/or respect • What does it lead to for the member? – Progressive successes – Being needed – Staff being able to use themselves as models (Messenger story) – Avoidance of isolation – Less of a chance for re-hospitalization – Staff utilizing other members as models – Staff involvement in multiple domains of a members life • Helps the member generalize their success at Fountain House to other situations • Guarantee that a member won’t fall through the cracks • Supports risk taking (story of coat room) ( the importance of success on a risky project. The member succeeds and then can generalize that success to other risky or fearful opportunities. • Protects against plateauing Staff Role as Transformational Designer The role of the Transformational Designer (designing and leading in the work of the FH community) – Shared leadership in decision making in the work – Organizing the daily work – Deconstructing the work for success – Discussing its relevance – The social climate of joyful hustle – Celebrating success – Promoting wellness 8
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