We are the Light, We are the Change
Somos la luz, somos el cambio
My reflections on Alternatives 2007, by Dan Fisher
 “We are the light, we are the change,” summarized my feelings about this excellent Alternatives. These are the words that our institute ended with. As those of us on the panel spoke the words, “we are the light, we are the change,” we reached out to the audience and one by one they reached back and held our hands. They picked up the chant. They in turn reached out and held the hands of their neighbors, who in turn picked up the chant. Large smiles spread across our faces. Then a Latina consumer led us in the same chant in Spanish. “Somos la luz, somos el cambio.” As we all entered into the Spanish version, the electricity between us intensified. Soon you could see by our expressions we were all feeling a new sense of joy. I could feel words bringing all my senses together, my feelings were welling up, my heart was brimming over, my thoughts were free to flow, and my skin felt the warm glow of spirits meeting spirits. We all ended by hugging and holding the feelings. I truly feel that the spirit of those words reflected the feeling of Alternatives 2007.
The institute “Getting a place at the table and gaining a voice” was presented by Joe Rogers, Sharon Kuehn, Lauren Spiro and myself. We also had two international consumer leaders who joined us by internet: Jenny Speed, Deputy Director of the Australian Mental Health Consumer Network, and Anne Beales, Management committee member of the National Survivor User Network (of England). The institute started with each of us sharing our story of how we came into the movement and the work we do. [More on Alternatives 2007]
Anne Beales Receives Member of the British Empire for Services to Mental Health
By Dan Fisher - December 10, 2007
 A very effective consumer advocate, Anne Beales, whom I met in Canada in August, 2007 has been awarded the important MBE by Queen Elizabeth. Anne has coordinated the formation of a national network of mental health consumers across England similar to the National Coalition of Mental Health Consumer/Survivors we are forming here. Anne is working with me and leaders from other countries to form an International Coalition of Mental Health Consumer/Survivors.
The following is a news release of the event:
Brighton [UK] -based campaigner Anne Beales has been awarded an MBE for services to mental health. A long-standing campaigner for mental health, Anne has fought tirelessly over many years to improve access to mental health services and the rights of those with mental health needs. (Click for more on Anne Beales)
Mental patients find understanding in therapy led by peers
By Carey Goldberg, Boston Globe Staff | June 8, 2007
TAUNTON -- Years ago, Jess Zaller came to the Pathways mental health program as a day patient. In and out of institutions, he had fought mental illness since childhood. His life felt like a nightmare of chaos and despair.
Zaller, 45, was back in a Pathways therapy group last week, but this time as a leader, listening carefully as members laid bare the pain of their fears and compulsions. When he delicately pointed the way, it was often in the first person, using his own hard lessons learned:
"Our lives are at stake," he told members. "It takes a lot of courage to walk a path of recovery, and each one of us develops our own path."
Massachusetts is beginning to develop a corps of people like Zaller who have been through the depths of schizophrenia, bipolar disorder, or depression, and recovered enough that they can help others with mental illness.
Such comradely aid has long been exchanged informally, or scattershot at mental health venues. But now the state has launched a new job category -- certified peer specialist -- meant to formalize these relationships and gradually, they hope, get peer counseling reimbursed routinely by insurers and Medicaid.
"There's something about receiving support from someone who's gone through exactly what you're going through now that people find invaluable," said Michael O'Neill, the state's assistant commissioner for mental health services.
A few handfuls of Massachusetts residents, including Zaller, have completed the eight -day training session and exams to be certified as peer specialists. On Monday, they are to be recognized at a State House ceremony.
The new field must work through many possible problems, from the potential for relapse among specialists to the potential for resistance from more traditional mental health staffers. But O'Neill expects the state's corps to grow to hundreds.
Massachusetts is redesigning its mental health system to be more user-friendly, he said, and "peer support is a fundamental element of that redesigned system." In the coming months, Massachusetts will be setting up six regional centers where peer specialists will work with clients and support each other in their fledgling vocation, O'Neill said .
The concept has taken off in 30 states. In half a dozen, Medicaid, the public insurance program for the poor and chronically ill, pays for the services, said Paolo del Vecchio, associate director for consumer affairs at the federal government's Center for Mental Health Services.
"Over the past five years, we've really seen the development of a new mental health profession emerging," he said.
The growth of the peer specialist profession comes against the backdrop of a sweeping national shift toward greater optimism that those in dire condition may improve or recover, and toward giving people with mental illness more control over the help they get. People with mental illness are not passive patients, the thinking goes; they can help themselves and as they get better, they can help others .
In their work, peer specialists are expected to share their stories of recovery when relevant to their clients. They may have learned skills worth sharing, or simply inspire hope by being much better than they once were.
The work goes beyond a typical speaker at a 12-step meeting.
It can include helping a patient in a psychiatric hospital make the shift back to living at home, or supporting an emergency room patient in crisis. A specialist might remind a team of clinicians that their patient is in a kind of hell, or take a lonely client out for pizza.
Early research, which is just beginning to accumulate, suggests that peer specialists may be particularly useful with patients who would normally resist help from the mental health system, said Larry Davidson, a Yale professor who conducts studies on peer specialists.
People with mental illness sometimes feel disliked by the professional staff who treat them, he said; it appears that with peers, "they feel less disliked and more understood."
Studies show that "people in recovery can provide services at least as well as people who don't have that experience," Davidson said. Hard data are being collected now on whether they offer "value added," he said.
Anecdotal reports of successful work by peer specialists abound. In Georgia, which has 340, they have proven particularly useful in helping discharged state hospital patients build new lives at home, said Gwen Skinner, the state's top mental health official.
Though the new field is growing, resistance remains, Davidson and others said. They worry that staff and clinicians without mental illness could feel threatened by the influx of newcomers whose experience with illness is considered an asset. Traditional staff could also worry about being replaced by peer specialists. Certified peer specialists are supposed to earn a typical mental health staff salary of $12 an hour to $15 an hour on an entry level, said Deborah Delman executive director of M-Power, the Massachusetts mental health advocacy group that runs the peer training courses. But some peer workers who are not certified may earn less, she said.
After they are certified, Massachusetts peer specialists will continue to be overseen by The Transformation Center, a statewide training organization that is supposed to ensure they maintain ethical standards and continue their education.
The peer specialists also pose staffing issues. What if, for example, a peer specialist works with patients at a state hospital, then has a relapse and is rehospitalized there, then resumes the job? Boundaries and definitions may get fuzzy; confidentiality may become a concern.
Also, Davidson said, if supervisors view their patients as problems, then adding peer specialists to their staff is asking for more problems. The challenge, he said, is for them to shift to thinking about all people with mental illness as "having assets and strengths to help solve problems."
Judging by responses in Zaller's small therapy group in Taunton, some people with mental illness immediately see the benefits of being helped by a peer.
"He's not looking at us through a book," said one group member, Diane Silvia. "He can relate to us, and we can relate to him."
Carey Goldberg can be reached at goldberg@globe.com - © Copyright 2007 Globe Newspaper Company.
**In accordance with Title 17 U.S.C. section 107, this material is distributed without charge or profit to those who have expressed a prior interest in receiving this type of information for non-profit research and educational purposes only.**
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Michael Hartman Appointed Commissioner of Mental Health, & Beth Tanzman Named Deputy Commissioner of Mental Health
Waterbury, Vt. – Agency of Human Services (AHS) Secretary Cynthia D. LaWare today announced several new appointments in the Agency. Michael Hartman was appointed Commissioner of the new Department of Mental Health (DMH), Beth Tanzman was named Deputy Commissioner of Mental Health and Brendan Hogan will serve as the new Deputy Commissioner of the Department of Disabilities, Aging and Independent Living (DAIL).
"These new appointments will help make Vermont stronger than ever in the service of individuals with mental illness, individuals with disabilities and our aging population," said Secretary LaWare. "In his role as Deputy Commissioner, Michael Hartman has impressed policy makers, service providers and consumers alike with his wealth of experience and thoughtful, decisive leadership style. I know he will make an outstanding Commissioner of Mental Health. And Michael will be ably assisted by Beth Tanzman, a proven leader whose professional credentials, determination and patience has almost single-handedly kept the Vermont State Hospital Futures Project moving forward. Brendan Hogan's in-depth knowledge of Medicaid and Medicare and his experience at the Office of Vermont Health Access (OVHA) will be a tremendous asset to DAIL and the individuals they serve."
Hartman was appointed Deputy Commissioner for Mental Health, in December, 2006, when Mental Health was under the Vermont Department of Health. Prior to that appointment, he served since June 2000 as Director of Community Rehabilitation and Treatment/Intensive Care Services at Washington County Mental Health Services, Inc. in Montpelier. He was also the Executive Program Director of Collaborative Solutions Corporation. CSC is the new service provider that established Second Spring, an 11 bed Community Recovery Residential facility in Williamstown, Vermont, which opened this spring. Since 1998, he has been an Adjunct Faculty member of the Southern New Hampshire University Program in Community Mental Health, Burlington site. Hartman has over 25-years of experience in the mental health and social work arena in Vermont. Hartman received his BA from Goddard College in 1982 and his Masters in Social Work from the University of Vermont in 1998. He is a resident of Montpelier.
Beth Tanzman has worked and consulted in public mental health systems for 18 years. Since November, 2005 she has directed the Vermont Mental Health Futures Project, a strategic planning process for the continued transformation of Vermont's public mental health system towards a consumer-directed, trauma-informed, and recovery-oriented system of mental health care. In this leadership role, Tanzman works collaboratively with all stakeholders in Vermont's mental health system to replace the existing 54-bed inpatient capacity of the Vermont State Hospital (VSH) with a new array of inpatient, rehabilitation, and residential services for adults. Prior to this, she served as director of Vermont's Adult Community Mental Health Services where she was a key leader in Vermont's mental health system change efforts. Before working for the State of Vermont, Tanzman was a consultant and researcher with the Center for Community Change through Housing and Support. Tanzman served as Chair of the National Association of State Mental Health Program Directors (NASMHPD) Adult Services Division (2000-2002) and is active in the national Evidence-Based Practices research and implementation. Tanzman received her BA from the University of Vermont in 1984 and her Masters in Social Work from State University of New York, Albany in 1988. She resides in Burlington. top of page
The evidence base for consumer-run services
"Grading the Evidence for Consumer-Driven Services." The UIC National Research and Training Center is offering this workshop as part of its National Web-Based Education Program. The speakers, Drs. Judith Cook, Jean Campbell, and Lisa Razzano discuss the evidence base for consumer-operated, delivered, and centered services, where people control the kinds of help they get, from whom, and in what settings. They present the evidence grading pyramid, along with the specific levels of evidence for models such as recovery self-management, drop-in centers, advance directives, and self-directed care. A special focus of this web cast is on the results of the national multi-site research study of consumer-operated service programs or COSP, directed by people in recovery and funded by CMHS. To view the web cast and download transcripts and slides, visit the Center's website at: www.psych.uic.edu/uicnrtc/webcast1.htm. The Center is supported by NIDRR and CMHS. top of page
Hoyer Received Award at the National Council on Disability's 15th Anniversary Observance of the ADA
Congressman Steny H. Hoyer (D-MD) was awarded the George Bush Medal for the Empowerment of People with Disabilities on July 25th, 2005, at the National Council on Disability's 15th Anniversary Observance of the Americans with Disabilities Act (ADA). Former President George H.W. Bush presented him with the award at an evening gala at the Kennedy Center for the Performing Arts in Washington, DC. In recognition of her years of cross disability advocacy, NEC's Judi Chamberlin was an invited guest. On the actual anniversary date, July 26th, NCD sponsored a seminar consisting of a number of workshops addressing various aspects of the ADA, at which a number of government officials spoke, including A. Kathryn Power, Director of the Center for Mental Health Services.
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State Mental Health Commissioners Say Seclusion and Restraint are Safety Interventions, Not Treatment Interventions
On July 13, 1999 the membership of the National Association of State Mental Health Program Directors (NASMHPD) approved a position paper on seclusion and restraint. The first two and a half paragraphs of the position paper read as follows:
NASMHPD Position Statement on Seclusion and Restraint
"The members of the National Association of State Mental Health Program Directors (NASMHPD) believe that seclusion and restraint, including "chemical restraints," are safety interventions of last resort and are not treatment interventions. Seclusion and restraint should never be used for the purposes of discipline, coercion, or staff convenience, or as a replacement for adequate levels of staff or active treatment.
The use of seclusion and restraint creates significant risks for people with psychiatric disabilities. These risks include serious injury or death, retraumatization of people who have a history of trauma, and loss of dignity and other psychological harm. In light of these potential serious consequences, seclusion and restraint should be used only when there exists an imminent risk of danger to the individual or others and no other safe and effective intervention is possible. P> It is NASMHPD's goal to prevent, reduce and ultimately eliminate the use of seclusion and restraint..."
To request a copy of this position paper contact the National Association of State Mental Health Directors' at 703-739-9333 or write them at 66 Canal Center Plaza, suite 302, Alexandria VA 22317 or you can contact them via their website at http://www.nasmhpd.org
State Medical Directors' Council Says Seclusion and Restraint are Security Procedures and are NOT Medical Treatments.
During February 18 -19 1999 a meeting was held in Atlanta Georgia. Participants included two state mental health commissioners/directors, five state medical directors, two representatives from state offices of consumer affairs, and representatives from other NASMHPD divisions, affiliates and staff. A report on reducing the use of seclusion and restraint was generated and a final draft was approved by the Medical Directors Council and published in July 1999. The paper is called, "Reducing the Use of Seclusion and Restraint: Findings, Strategies and Recommendations." To request a copy of this position paper contact the National Association of State Mental Health Directors' at 703-739-9333 or write them at 66 Canal Center Plaza, suite 302, Alexandria VA 22317 or you can contact them via their website at http://www.nasmhpd.org
Under the section of the report titled "Problem Statement: Definition of the Issues and Consensus Reached by Participants," the following was written on pages 3 and 4:
"Definition of the Issues
The issues raised by the use of seclusion and restraint in the mental health system go far beyond a narrow focus on the techniques involved in the use of these interventions. The overutilization of seclusion and restraint can be seen as a symptom of a larger problem in the culture of the clinical environment. An effective approach to this issue will, therefore, need to include consideration of clinical and cultural issues."
"Misapplication of the techniques of seclusion and restraint creates safety problems for both the individual and the staff involved. The rate of work-related injuries is higher in mental health than in the construction industry, and more staff injuries occur during the implementation of seclusion and restraint than occur from unexpected assaults. Thus this report will take a broad, inclusive approach to the issue of the use of seclusion and restraint, attempting to convey some of the complexities involved. The report begins with a discussion of prevention and early intervention, and then identifies standards for safe and effective implementation."
"In a fundamental way, this issue is about how mental health systems treat the people they serve. If the goals of the public mental health system are to treat people with dignity, respect and mutuality, to protect people's rights, to provide the best quality care possible, and to assist people in their recovery, any use of seclusion and restraint must be rigorously scrutinized. Many people enter the mental health system for help in coping with the aftermath of traumatic experiences. Others enter the system in hope of learning how to control symptoms that have left them feeling helpless, hopeless, and deeply fearful. Still others enter the system involuntarily. In these cases, the need for treatment has been expressed by the committing authority, not by the recipient. Any intervention that recreates aspects of previous traumatic experiences or that uses power to punish is harmful to the individuals involved. In addition, using power to control people's behavior or to resolve arguments can lead to escalation of conflict and can ultimately result in serious injury or even death."
"Consensus Reached by Participants
Given that seclusion and restraint are virtually always experienced by the individuals involved as traumatic, put both staff and patients at risk, and can seriously jeopardize the treatment milieu, are there ever instances when these interventions are justified? It was a consensus of those present that seclusion and restraint are justified only if they are being used for the clearly defined purpose of maintaining safety and if all other, less intrusive interventions have failed. Clearly, these factors will vary according to setting, with acute care and emergency room settings presenting a different challenge from long-term care settings. For example, substance abuse is more likely to be a complicating factor in emergency room settings than in long-term care facilities. Similarly, the justification for the use of seclusion and restraint may vary over time even within the same setting, depending on what other alternatives have been tried and on other factors affecting the basic safety of the unit."
"Regardless of the context, is critical that seclusion or restraint be used only as a "last resort measure" to maintain safety. Substantial care must be taken to define the situations in which safety concerns are strong enough to justify the use of seclusion and restraint. Seclusion should be used only in situations of imminent risk to self or others or serious disruption to the treatment milieu, restraint only in situations of imminent risk. Neither technique should ever be included as part of an individual's treatment plan, or as part of the day-to-day management of a unit. Finally, these interventions should under no circumstances be used as a threat, either implicitly of explicitly, nor should they ever be used as punishment."
"Seclusion and restraint should be considered a security measure, not a form of medical treatment. However, given the medical risk of serious injury or even death posed to recipients, the use of seclusion and restraint should be medically supervised."
"In addition to seclusion and restraint, it is imperative that other forms of control be closely monitored to ensure that one potentially abusive practice is not substituted for another. In particular, the use of emergency psychotropic medications should be closely monitored. When used properly, psychotropic medications can be helpful in treating agitation due to mental illness, allowing a complete clinical and medical assessment to be done. However, drugs should not be used solely to immobilize or sedate people as a mechanism for control. Over-medication and polypharmacy are of particular concern with children. Similarly, the use of law enforcement and stringent behavioral programs, while appropriate under some circumstances, should always be monitored to prevent misuse."
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