Project GREAT: Bringing Consumerism to Mental Health Education and Services Department of Psychiatry and Health Behavior Medical College of Georgia, Augusta, GA - PowerPoint PPT Presentation

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Project GREAT: Bringing Consumerism to Mental Health Education and Services Department of Psychiatry and Health Behavior Medical College of Georgia, Augusta, GA


Joseph S. Ricci, PhD Administrative Director '...the mental health delivery system is fragmented and in disarray. ... Buzz Aldrin - Astronaut ... – PowerPoint PPT presentation

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Title: Project GREAT: Bringing Consumerism to Mental Health Education and Services Department of Psychiatry and Health Behavior Medical College of Georgia, Augusta, GA

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.
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
Half of the lifetime cases of mental illness
begin by age 15 and three-quarters by age 24
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
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
  • 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
  • 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
  • Noncompliance rates well over 50 for most
    medication treatments of major psychiatric
    disorders often not detected by the provider.

Access to High Quality Care
In the National Comorbidity Study 78.2 of mood
disorders and 95.9 among nonaffective psychoses
did not receive minimally adequate mental health
  • Wang, Berglund, Kessler, 2000

Have Psychiatrists Become Medication Managers?
  • From 1987 to 1997
  • Percent of patients receiving medications
  • Average number of visits declined from 12.6 to
  • Olfson et al., 2002

Traditional Psychiatric Care
Case Vignette
  • Surgeon Generals Report on Mental Health of
  • 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.

  • 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

Stigma- Mental Health Care
  • 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
Houses by an unnamed child from Vienna
Buzz Aldrin - Astronaut
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
  • Transcends the exclusive focus on symptom
    reduction that marks the traditional medical
  • Instills hope while emphasizing a non-linear
    process of recovery that includes setback and
  • 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 Model
  • 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
  • Self-Determination
  • Self-Efficacy
  • Support

Diane Arbus - Photographer
Project G.R.E.A.T.(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
  • Peter F. Buckley, MD
  • Gareth Fenley, MSW
  • P. Alex Mabe, PhD
  • Scott A. Peebles, PhD

Project G.R.E.A.T.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
  • If it aint broke, dont 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
  • No consumer presence on hospital/clinic advisory

Tom Harrell - Jazz Musician
Project Great Defining and Refining as we go.
  • Phase I Bringing on a Certified Peer Specialist.

A Peer Specialist 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
  • 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

The Peer Specialists Role
  • Part of a multidisciplinary team
  • Does not treat symptoms
  • Offers role modeling and teaching about Recovery

The Georgia Certified Peer Specialist (CPS)
  • High school diploma or GED required
  • Competitive admissions process
  • Two-week training
  • Certification exam
  • Continuing education

Peer Support in Georgia
  • 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
  • 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
  • Obtaining administrative clearance to hire the
    CPS took a year after grant funding began
  • CPS credential is not recognized by MCG hospital
  • 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
  • Faculty, staff, and residents at all levels have
    welcomed the CPS
  • Expressed attitudes toward CPS on team have been
  • 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
Project Great 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?)
  • 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
  • Physical logistics (locked units, unmarked
  • Procedural logistics (heightened confidentiality,
    separate and often lesser insurance benefits)
  • Funding
  • Affecting patients
  • Affecting families
  • Affecting care providers

MCGs Commitment
  • Vision To be a national leader in patient and
    family centered teaching, research and care
  • PFCC inaugurated in childrens medical center
  • MCG featured in PBS series Remaking American
  • Under leadership of VP Patricia Sodomka, FACHE,
    expanding PFCC to entire MCG enterprise
  • Top Level Departmental Leadership has attended
    meeting and supported the enterprise.

MCGs Behavioral 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
  • 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

Sigmund Freud Psychiatrist, Scientist
Project Great Defining 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
  • 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.

Natalie Cole - Singer
Jack Dreyfus Business Leader
Eleanor Roosevelt Political Leader
The Primacy of Choice and Personal
ResponsibilityExample 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,
The Effects of Choice and Enhanced Responsibility
  • Good care by the staff on behalf of the
    residents resulted in 71 becoming more
  • 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,
Follow-Up Rodin 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.
Georgia Recovery Assessment Form
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_________________
Georgia Recovery Assessment Form - continued
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/reli
gious support Substance Abuse Program
Monica Seles Tennis Champion
Workshop II All about Attitudes
  • Focused on reversing negative stereotypes
    regarding those individual living with mental
  • Provided real examples of individuals in
  • Emphasized the stories and less so the
  • Hearing first hand from providers who have
    transformed their practice to the Recovery Model.

Workshop II clips
Ray Charles - Musician
Project Great Defining and Refining as we go.
  • Phase IV Putting the Recovery Model into

Follow-Up Implementation of the Georgia 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

Putting into Practice - More
  • Putting the Certified Peer Specialist into the
  • Keeping the fire under the Behavioral Health
    Advisory Council.
  • Data Collection.
  • Relaunching the GREAT Steering Committee.

Preliminary Findings
  • Workshop I Knowledge of Recovery significantly
  • Workshop II Attitudes regarding the
    capabilities of those with mental illness to
    actively participate in their care significantly

Lot Easier Said than Done
  • Where are the referrals for the Certified Peer
  • Logistics of incorporating a Certified Peer
    Specialist into a traditional academic
  • Getting administration to listen to the
    Behavioral Health Advisory Council
  • Changing practice habits is hard!

Next Steps
  • 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
  • Establish participative decision-making
    Establish faculty and resident focus groups.

Dr. Patricia Deegan and Associates- Clinical
Psychologist, Author, and Co-Founder of the
National Empowerment Center Inc.
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