[spiritual_emergency]

From time to time I do come across information on alternatives to hospitalization and thought it would be helpful to initiate a thread where information on such programs can be stored. I believe there is a tremendous need to alternative forms of care, both for the sake of the individual in crisis, their caregivers, and larger society.

It's possible your community might have an alternative to hospitalization program in place. If they don't, perhaps you could get the ball rolling, using the following information as possible models to follow.

[spiritual_emergency]

The following is an excerpt only. For the full article, click on the source link at the bottom of the article.

When you click on the link a recorded interview will automatically start. I found it distracting so I simply turned the volume down while I read.

... The idea for an effective treatment alternative to hospitalization goes back to the early 1970s. Loren Mosher, a psychiatrist in Northern California, decided to test his theory that a therapeutic milieu could be just as effective as the standard of care in reducing the symptoms of schizophrenia. His research led to a program called Soteria, and its offspring, Crossing Place, came about a few years later in 1977.

Several research studies validated his claim, demonstrating that alternatives to hospitalization, when implemented correctly, can be more cost-effective and have equal symptom-reduction and recidivism rates compared to a hospital stay.1, 2 Such "crisis bed" facilities also allow clients more integration with the community during their stay and can offer more freedom and autonomy than a hospital allows.

Jordan House's staff has attempted to closely follow the original Crossing Place model. The following are some components that have been suggested as essential to the accomplishments of similar programs:

- maintaining a small and homelike family environment with two staff members, a man and a woman, on duty for 24-hour shifts;
- providing intensive one-on-one support by "being with" and "doing with" residents without being intrusive;
- having a minimal hierarchy so residents are encouraged to maintain their autonomy;
- offering supportive counseling and therapeutic activities such as art, outings, gardening, shopping, and cooking, but no formal therapy; and
- encouraging residents to maintain relationships with the staff, program, and other alumni following discharge.

These essential ingredients helped guide the formation of Jordan House's program.

Although psychotropic medications were not used in the original Soteria model, they were routinely used in its offspring, Crossing Place, and are an important part of the Jordan House program, as well. Jordan House staff and psychiatrists emphasize the importance of receiving accurate information about each medication prescribed so that residents can make an informed choice to continue the right medications without coercion after discharge.

In its first two years, Jordan House's staff excelled in quickly stabilizing residents' psychiatric symptoms. They accomplished this by creating an environment that enabled residents to:

- form positive relationships that continue after their stay is complete;
- develop coping methods to prevent another crisis;
- connect with desired resources in the community; and
- build independent living skills.

Outcomes
The therapeutic ingredients outlined above have resulted in positive outcomes for our residents. Of 147 residents served in the first year, only 5 required a transfer to hospitalization during their Jordan House stay. Jordan House's level of care, although much less restrictive than a hospital, was capable of successfully stabilizing psychiatric symptoms for 85% of our residents with severe and acute mental health symptoms. For its efforts, Jordan House was recognized with a 2006 Lilly Reintegration Award.

Source: Jordan House: A Community Alternative to Hospitalization

See also: Loren Mosher & Soteria House

[spiritual_emergency]

The re-solve program in Pittsburgh...

Crisis Centers vs. Emergency Rooms

The first time Mike became psychotic, I drove him to a hospital emergency room. We didn’t know any psychiatrists and Mike needed immediate help. Taking him there turned out to be a mistake.

Emergency rooms are where everyone goes nowadays whenever they have any kind of health-related crisis, but many are poorly equipped to deal with psychiatric patients in the midst of a mental break.

Some patients are turned away, as Mike and I were, without getting help. Or a patient might be held down and given a shot of Haldol or another strong anti-psychotic that will help stabilize him but also can turn him into a walking zombie for days.

How a person is treated when they have their first major breakdown is important. If the first time you went to see a dentist, he pulled one of your teeth without giving you novocaine, how eager would you be to ask him for help the next time you had a toothache? The same is true about a mental breakdown.

This is why many progressive communities are shifting the focus from emergency rooms to crisis clinics specifically designed to help people who are experiencing some sort of behavioral or emotional breakdown.

Jewel Denne directs a clinic for re:solve Crisis Network in Pittsburgh, which is part of the University of Pittsburgh Medical Center, and last weekend she explained to an enthusiastic audience attending a conference hosted by the Southwestern Pennsylvania chapter of the National Alliance on Mental Illness how her clinic operates.

The first step the clinic’s planners took was talking to persons with mental illnesses and their families. They asked them what sort of services might be needed in the clinic and what was the most effective way to offer those services to persons in need. The clinic’s directors asked them to describe good and bad experiences that they’d had. They even asked for ideas about how the building should be designed, down to what color the walls should be painted.

Asking families and consumers (persons with mental illnesses) for their opinions may sound like an insignificant thing, but it isn’t. One of the biggest myths about mental illnesses is that persons, who are sick, are psychotic all of the time and therefore can’t be trusted to know what’s good for them. This attitude dates back to days when a patient had no voice in how he/she was treated.

Who better to ask than someone who has been through treatment and their family members about what works and doesn’t? All to often, family members are cut out of the process or seen as enemies.

Because of the input of family members and consumers, the center ended-up looking like a neighborhood Starbucks rather than a hospital.

Denne said her clinic receives an average of 8,000 calls a month and 770 walk-ins seeking help. The clinic has medical personnel on duty but its primary job is plugging people into the right services that they need to recover. The clinic also operates a mobile crisis team that goes anywhere in Pittsburgh to evaluate someone who is having a crisis. It doesn’t matter if they are in their home, a park, or on a street corner.

The mobile crisis team performs about 800 evaluations per month and in 85% of those cases, it is able to help the person without admitting them into a hospital.

Open 24 hours per day with a staff of 130, the crisis center’s credo is “engagement is the key.” Denne explained that her counselors try to develop a trusting relationship with clients. When that happens, the chances of getting someone to agree to treatment and comply with medication and other services greatly improves.

Peer-to-peer specialists are a crucial part of the center’s staff. Pennsyslvania has become a leader in training and hiring peer-to-peer specialists and now boasts more of them on the payroll than in any other state.

A peer-to-peer specialist is someone who has a mental illness and is now stable. The idea of having a person with a mental illness help another person with a mental illness was met with much skepticism at first. But the impact it has had in Pennsylvania is phenomenal, according to Joan Erney, the state’s outgoing deputy secretary for Mental Health and Substance Abuse.

Peer support is not much different from having someone who is a recoverying drug user or alcoholic help another addict. Someone who has been down the same road is a better guide than someone who hasn’t.

More than a year ago, I visited a similar crisis clinic in San Antonio, Texas, and was impressed not only with the emergency services that it provided but with its cost effectiveness. An audit showed the city was saving significant sums by using its drop off center rather than emergency rooms.

Of course, if a person is psychotic and doesn’t believe he is sick, the job of helping him becomes much, much more difficult. This is why a few of the persons who come to the clinic end up in a hospital involuntarily.

In a twist, Denne said that the 911 operators in Pittsburgh often referred calls to the clinic. She also said that calls to the center came in many different forms. One caller said he was in crisis because he couldn’t get dog food for his pet. When Denne’s workers investigated, they discovered that the caller had schizophrenia and not only was out of food for his pet, but also had no food for himself.

Crisis centers are gaining in popularity, especially with family members. Too many of us have needed help only to have the police arrive and watch as someone we love is handcuffed and driven away to an emergency room.

Source: Pete Earley's Blog

[spiritual_emergency]

An idea from Ireland...

A Better Way to Mental Health...


A decade of hard work has come to fruition for Joan Hamilton with the establishment of the Slí Eile farm project

It's taken 10 full-on years – longer if you count the heartbreaking years of a daughter’s illness – but Joan Hamilton’s dream of a residential, farming community where people with mental health difficulties can work to rebuild their lives is about to become a reality.

A force of nature when it comes to getting things done, Hamilton is the woman behind the Slí Eile farm project, behind Villa Maria (the Slí Eile pilot venture running in Charleville, Co Cork for three years now) and behind the venture’s vision of “an Irish society which accepts people’s mental illness and confusion and supports their unique journey to recovery”.

The Slí Eile farm fund was launched last week by the project’s patron, actor Jeremy Irons. Speakers at the event included Healthplus columnist Tony Bates, Prof Ivor Browne and Carmel Fox of the Cork County Development Board.

Irons, in a heartfelt speech, spoke of everyone’s right to self-respect and a sense of worth, about the importance of mental healthcare, his belief that Slí Eile Farm was both “terribly important and made sense” and his conviction that it would succeed “because of our fantastic leader, Joan Hamilton”.

Similar farm communities in Massachusetts and Ohio have been guiding influences in the development of the Slí Eile model. There is support, too, from Jersey in the Channel Isles, where Joan Hamilton was born and lived until she met Gerry Hamilton, the Irishman she married and came to live with in the Co Cork village of Dromina more than 40 years ago.

She spoke about it on a recent sunny day at Villa Maria, where the pilot project is now providing accommodation for five tenants and one support staff. The cared-for gardens were ready to bud if not bloom, tenants were engaged in the daily schedule of work (including baking bread and scones which are supplied to the local community) and the house cat was stalking this reporter.

When did she start, and why? “I set up a lobby network group around 2000. The why had to do with a lifetime watching my daughter Geraldine’s steady deterioration in the traditional psychiatric system. Figures from the mental health inspectors show that three out of four psychiatric admissions are readmissions – soul destroying for the person as well as for her/his family. I’d been banging on doors forever and felt helpless, frustrated and that there had to be another way, a better way.” She smiles. “A Slí eile.”

The germ of the idea goes back even further. Geraldine is the third of Joan and Gerry Hamilton’s six grown children and her mental health difficulties began as a teenager in the 1980s.

“Her situation, in the traditional system, was pretty appalling at times,” her mother says with gentle understatement. “I didn’t think things could get worse, so I went public and did an interview with RTÉ Cork and that connected me to like-minded souls and that, basically, is how it started.”

In 2001, as co-founder of Cork Advocacy Network, she organised a stake-holders conference entitled Is There Another Way? in Cork city. “Vincent Browne chaired the day and more than 700 people turned up. It was a great success. From a reading of Toxic Psychiatry by Peter Breggin I’d learned about therapeutic communities, so the idea took root, but I didn’t know how to go about setting one up.

“I’d studied choice theory/reality therapy with the William Glasser Institute and what I learned came together in therapeutic community ideals of respect for one another and regaining control of lives lost. I returned to adult education in UCC, studied community development, disability studies, interpersonal communications and applied social studies. It all helped me see how others worked to bring about change and gave me real belief in the possibility that those with mental health difficulties could both recover and regain control of their lives.”

She set about the difficult task of getting funding for social housing. “Villa Maria was achieved after a series of abortive attempts due to problems caused by the stigma and attitudes to those with mental health difficulties.

“But it happened,” she smiles again, “and Villa Maria has been successfully running since 2006. The present five tenants are all growing in self-sufficiency, self-knowledge and self-worth. Everyone’s responsible for their own medication and the role of staff is to help tenants regain life skills.”

With a larger community, “something that’s going to continue long after me” in mind, she spent two weeks last year working as a volunteer at Hopewell community farm in Cleveland, Ohio.

“I saw how it was set up and how it worked. I loved the sense of calm, the reality of structures impacting on people’s lives. I saw the evidence before my eyes of lives recovered and being lived. I came back energised and enthused.”

There’s been the recent, added momentum of enthusiastic support from Gould Farm in Massachusetts too, a community which dates from 1913 and is the oldest such in the US.

Slí Eile farm will provide a supportive living environment for up to 16 people with mental health difficulties. Everyone will be involved with the daily running of the farm, which will provide housing for at least two residential staff, four volunteers, a residential events venue and farm shop.

Allotments will be available to families in the area, all of which will make for social interaction and revenue.

The Slí Eile farm fund aims to raise money for the purchase of 80-100 acres as well as for staff, buildings and more.

Joan Hamilton has developed and managed her own food processing business, been involved with local tourism, small businesses and administered EU Leader funding. As executive director and founder of Slí Eile farm she projects it will break even by 2014. The projection that it will bring hope and inspiration to the area of mental health care in Ireland is a given.

Source: The Irish Times: A Better Way to Mental Health

[spiritual_emergency]

From Finland...

Jaakko Seikkula, Ph.D. is a professor at the Institute of Social Medicine at the University of Tromso in Norway and senior assistant at the Department of Psychology in the University of Jyvskyl in Finland. Between 1981-1998, he worked as a clinical psychologist at the Keropudas hospital in Finland where he and colleagues developed a highly successful approach for working with psychosis known as Open Dialogue Treatment (OPT). The approach de-emphasizes the use of drugs and focuses instead on developing a social network of family and helpers and involving the patient in all treatment decisions. Ongoing research shows that over 80% of those treated with the approach return to work and over 75% show no residual signs of psychosis. Official government statistics comparing 22 health districts in Finland found that Dr. Seikulla's district was the only one not to have any new chronic hospital patients in a two year period and led the National Research and Development Center for Welfare and Health to award a prize for "over ten years ongoing development of psychiatric care".

Source: New Practice With Psychotic Patients

See also: A Two Year Follow Up [PDF File]

[spiritual_emergency]

A successful program, similiar in some respects to Loren Mosher's Soteria House, that was in operation in San Francisco during the 70's...

"...85% of our clients (all diagnosed as severely schizophrenic) at the Diabasis center not only improved, with no medications, but most went on growing after leaving us."

- John Weir Perry

John Weir Perry

The Facility: Diabasis was an experimental project in San Francisco. It was a residence facility that lived through three years and more of inpatient work with acute "schizophrenic" episodes in young adults without the use of medications, always as part of the county's community mental health system. Its purpose was to provide a home in which clients might have the opportunity to experience with full awareness their deepest processes during this intense turmoil.

Staffing: The facility was staffed by twenty paraprofessionals who served not only the ordinary functions of attendants, but also provided psychotherapy as counselors. Some of these held fractions of our seven paid positions, while others were volunteers. Although this arrangement brought the secondary benefit of lower cost, it's primary purpose lay in selecting individuals by disposition rather than by professional category; we picked ones who by qualities of empathy and ease with psychic depth were particularly suited to this work, whom we could then educate and train on the job.

Theory and Method: The orientation ultimately derived out of a Jungian approach although not all staff were specifically given to that theory and method; instead, several modalities were drawn upon. There was a consensus on the basic viewpoint that the acute "psychotic" episode under discussion typically contains elements of a spontaneous reorganization of the self and that therefore, if handled well, may result in self-healing. The therapeutic aim was to avoid the damage of labeling and disqualifying attitudes and instead, to respond to all that happens intrapsychically with honest feeling; also it was to validate the efforts the psyche makes spontaneously to effect a transition from a poor state of organization of the self to one that is more suited to the nature of the particular individual's disposition. The processes expressed in the imagery and emotion frequently lead to profound changes in one's outlook and lifestyle, specifically in one's cognitive structures, value system and belief system.

Progress of Therapy: Our most surprising finding in the case of early acute episode was that grossly "psychotic" clients have usually come into a coherent and reality-oriented state spontaneously within two to six days, without need for medications. We have found that our work was most effective with those acute early episodes that were productive of imageful content. With clients who came to us in their third or fourth episode, we often found that their experience was beneficial but the outcome less striking. Chronicity was another matter and the chances of fruitful experiences more uncertain. A history of heavy medication usually made it difficult to do effective psychotherapeutic work.

Conclusions: Returning to the question of what alternative programs can be, we arrived at certain conclusions. Such a program can be much more than benign mileau therapy. It is possible to do effective psychotherapy in the acute episode, since the client's talk is clear and the material of dynamics active and ready to hand. The use of medications can be reserved for backup alone, for the rare times when behavior becomes too hard to handle and after other psychological means have been attempted.

Therapy is best conducted in the spirit of nondoctrinaire openess to learn from the clients what the experience of their altered states is, and what it feels like to go through this process, and thus to be of help in facilitating its own aims toward reorganizing the self. When allowed to proceed, we find that a growth process is often underway that can be sustained, with consequent developments in one's system of meanings, value, beliefs and lifestyle. This treatment mode may then help avoid the devastating picture of incapacitation and recidivism that now prevails, and then becomes a burden to mental health systems.

The cost-effectiveness of such a program depends entirely upon its use by the community to handle acute and early, if not first, episodes, with the prospect that these clients might be benefited in such a way that they would no longer remain indigents, dependant upon the county for aftercare.

Source: Trials of the Visionary Mind: Spiritual Emergency and the Renewal Process

See also:
Diabasis - Prague, Czech Republic
Benefits of Informal Psychological Helping

[spiritual_emergency]

Windhorse Community Services, out of Boulder, Colorado...

Providing creative, home-based approaches to challenging treatment needs since 1981.


Significant recovery from serious mental disorders and related conditions (such as schizophrenia, schizoaffective disorder, bipolar disorder, Asperger’s, and dual diagnosis) is more achievable in an optimal situation. We provide a complete range of services to promote recovery:

• Intensive outpatient recovery team
• Individual treatment residence
• Psychotherapy
• Basic attendance
• Psychosocial supports: recreational/fitness, vocational, educational, community
• Medication coordination and home delivery
• Adjunct treatment to pre-existing care
• Family education and consultation
• Long-distance consultation
• Evaluation and referral

Individual treatment programs are tailored to suit each person's needs and resources. We bring our compassionate, whole-person perspective to all of our work.

Our Clinical Model Genuine RecoveryWindhorse Program Scenarios


Our Clinical Model

Two central principles, three core practices

The Windhorse model is organized around two central principles.
First, that each person is fundamentally healthy and sane and that a mental disorder exists as a secondary overlay to that sanity.
Second, that a person's health is inseparable from that of the environment. Therefore, if a person can be properly worked with in a relatively healthy environment, then the strength of his or her intrinsic health and sanity can emerge and recovery will be more possible.
The success of the Windhorse model is due to the accurate treatment of a particular condition within a healthy and supportive environment. Particular conditions can include schizophrenia, schizoaffective disorder, bipolar disorder, Asperger’s, autism, and dual diagnosis.) We view a client’s environment as having three primary aspects:

1. His or her physical, domestic life,
2. Interpersonal relationships and emotions, and
3. Mind, which includes thoughts, attention, and the general sense of personal presence and meaning.

These three aspects relate directly to our three core therapeutic practices:

1. Close attention to domestic activities: Both the therapeutic team and the client attend to the everyday workings of domestic life, including food preparation and cleanup, good diet, housekeeping, laundry, yard work, hygiene, finances, physical exercise, and other appropriate jobs. The client's household is the locus of the team's work.
2. Establishment of healthy relationships: At first, the members of the therapeutic team provide the client's primary relationships. Later, those relationships become a bridge for the client to establish healthy, nontreatment-related contacts in the wider community.
3. Stabilized schedule: Mental disorders disturb basic rhythms of eating, sleeping, rest, and activity. Restoring and stabilizing life rhythms through careful attention to daily living patterns is critical to recovery. By working closely with both the client and his or her environment, the whole situation becomes integrated. This integration minimizes conflicts that undermine recovery and maximizes the client's sense of security.

Our essential clinical practice for integrating a person with his or her environment is "basic attendance." This is a subtle combination of being with the person with the skill and understanding of a therapist and the warmth and empathy of a friend. It involves engaging with the person in ordinary activities of daily living. We provide help to the client in accomplishing problematic tasks, expanding into areas of interest, scheduling sane rhythms of activities, and furthering personal awareness. In some cases, basic attendance can be provided by a sole team member.

If the client's needs are greater, then a team is assembled. Coordination of communication among all Windhorse clinicians and outside service providers is carried out through regular team meetings. Family members are included as active collaborators throughout the treatment process so that our work is informed by them and they, in turn, are supported and educated by us. Constant attention to collaborative learning among family members, the client, team members, and outside providers arouses the real spirit of the Windhorse work. We promote a client's genuine recovery by helping him or her develop a wholesome domestic environment, healthy relationships, and self-knowledge.

_____________________________________

There is something magical, something hard to name, that happened in my Windhorse team. It had to do with connections created through gentle attentiveness and genuine care in the midst of, what for me was, a time of disconnection and extreme despair.

I felt held by the team in a supportive way, not stigmatized as the “sick patient” as I’d experienced in hospital settings. My basic well-being was attended to and cultivated in a climate of trust, collaboration and open communication. Everyone on the team, not just me as the client, learned and grew from the experience.

The Windhorse shift or Basic Attendance can look quite ordinary from the outside, involving activities such as walks, meal preparation, cleaning the living space or simply sitting together. But from the inside the extraordinary is taking place. The extraordinary is human contact. It is the recognition and practice of humanness that really sets Windhorse apart from other mental health models

— A client-graduate.

Source: Windhorse Community Services: Our Clinical Approach

See also: Recovery From Psychosis at Home

[SophiaG]

wow this is a great thread