Transcript Interventions to Reduce Racial Disparities in the

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
Definitions of Recovery
(Philadelphia DBH/MRS, 2006)
• 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.
More people in the community
(PA Data)
19911992
19941995
19981999
20022003
PEOPLE 6,120
4,934
3,205
2,309
# of Individuals in Pennsylvania State
Hospitals at end of fiscal year
…but NOT OF the Community
• 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
Modest Residential Segregation:
Poverty a Major Barrier
From Metraux, Caplan, Klugman, Hadley (in press)
Social Roles
• 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)
Community Integration Legal and Policy
Grounding
• 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 Definition
• The opportunity to live in the community, and be
valued for one’s uniqueness and abilities, like
everyone else (Salzer & Baron, 2005)
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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 Drives
Participation and Facilitates Recovery
(Salzer & Baron, 2005)
Community Integration Outcomes
Community
Integration
(Opportunity)
Community Presence
and Participation
Well-Being and
Recovery
Community Integration Principles
• Paradigm shift in views about disability
– Old paradigm: “Disability” is something inherent within
an individual
– New paradigm: “Disability” results from a personenvironment 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 Practice: Roadmap to Recovery
CI Domain
Address Barriers
Provide Supports
Housing
affordable housing: low quality
neighborhoods
Supported housing
Employment
Encouragement; labor market
liabilities; transportation
Supported employment
Education
Financial aid; unsupportive
environments
Supported education
Leisure/
Recreation
$$ available for memberships;
getting discounts; increase
community acceptance
Increased focus on leisure and
recreation
Social roles
Laws
Parenting classes; dating services;
family psychoeducation
Peer support
Negative views; funding
Self-help groups; COS
Health status
Provider attitudes; increase
integration
Health CHECK; PCP integrated in
MH settings
Citizenship
Laws
Information and encouragement
Self-determination
Negative views; lack of desire to
give up power
PAD; board participation; vouchers;
self-directed care models (e.g., circles
of support)
Breakout Groups
• Question to be answered: How can community
psychiatrists facilitate recovery in policy,
programs, and practice?
Policy and Program Groups
• Go through each domain (housing, employment,
education, social roles, peer support,
citizenship, leisure/recreation, spirituality, selfdetermination) 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?
Practice group
1) How can hope be promoted in treatment?
2) How can self-determination be facilitated
in treatment?
3) How can opportunity in the various life
domains (e.g., housing, employment,
education, social roles, peer
support, citizenship, leisure/recreation,
spirituality) be promoted in treatment?