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Online Articles

• Carroll: The stigma of mental illness
• F.D.A. Requiring Suicide Studies in Drug Trials - New York Times
• Globe Editorial: First, Try To Help
• Mental Health Wards Restrict Access to Email
• Mental patients find understanding in therapy led by peers
• Psychiatric patients feel strain
• Right to fresh air sought for patients
• Who is My "Peer" in a "Recovery Learning Community"?

Carroll: The stigma of mental illness

The MetroWest Daily News
By Iris Carroll, Guest columnist
GHS
Tue Jan 22, 2008, 12:19 AM EST



Have you ever wondered what lies buried beneath the stigma of mental illness?

Is it fear?

Maybe. But in spite of the media's tendency to sensationalize crimes committed by people who have been treated for mental illness, studies have shown that as a group, people living with mental illness are no more likely to be violent than the general population.

In fact, our country's own history includes people who have made major contributions to our society while at the same time struggling with mental health problems. Icons like Lincoln, Beethoven, Hemingway, Michelangelo, Churchill, and Dickens all experienced one of the major mental illnesses.

So why do we put so much distance between ourselves and other human beings who are obviously suffering and in need of comfort, instead of reaching out to them to help or offer support?

At Programs For People, clients recount stigmatizing events, painfully endured. They have lost friends after being hospitalized for psychiatric reasons. They have been ostracized by co-workers following a psychiatric hospitalization.

They say they have been stigmatized for being unemployed, been called "lazy" by family members, and pressured endlessly to get a job. They have even been asked inappropriate, probing questions by non-psychiatric, medical professionals.

It seems as though effects of stigmatization are almost as toxic as the illness, itself.

Why do kids pick on other kids who seem different? Why do adults denigrate others who appear to fall out of the norm?

Is it something deeply imbedded within the human psyche, some perverse Darwinian striving for survival of the fittest? Does it make us feel more sure of our own sanity to question the sanity of others?

In truth, relating to the strengths of anyone is much more personally rewarding than focusing on perceived weaknesses. In spite of our need for individuality and uniqueness, we all long to feel connected. We yearn to belong, to be understood, and to fit in somewhere.

Often when clients at Programs For People finally get up the courage to express the way they feel, they are absolutely amazed to find out that others have felt the very same way. When staff tell them that "lots of people, not just those with mental health issues, feel that way" they are incredulous.

Stigmatizing has lessened to some degree because, fortunately or unfortunately, these days almost everyone knows a relative, friend, or co-worker who has experienced mental illness.

In those instances, when we know and care about someone, it's easier to see them as a person who happens to have a mental illness. Too often, however, those whom we do not know are defined, in entirety, by the illness.

We need to look deep inside of ourselves about this, with greater compassion. What if it happened to us?

Once a client leaned forward and said to me, with incredible emphasis and feeling, "Do you know what it's like to hear someone whispering in your ear all the time?"

Even though I knew through my work that some people with mental illness hear voices, I was stunned. For the first time, I really imagined and felt what that would be like.

Put yourself there. Not easy to handle.

What helps people who have experienced mental illness feel better about themselves is knowing that there are people who care, understand, and stand by them - people who know that even with the illness, we are all still much more alike than different from each other.

Iris Carroll, MPH, is director of Programs For People, a Framingham-based agency that helps people to recover from mental illness and become employed.

F.D.A. Requiring Suicide Studies in Drug Trials - New York Times

The New York Times
Printer Friendly Format

January 24, 2008
F.D.A. Requiring Suicide Studies in Drug Trials
By GARDINER HARRIS

After decades of inattention to the possible psychiatric side effects of experimental medicines, the Food and Drug Administration is now requiring drug makers to study closely whether patients become suicidal during clinical trials.

The new rules represent one of the most profound changes of the past 16 years to regulations governing drug development. But since the F.D.A.’s oversight of experimental medicines is done in secret, the agency’s shift has not been announced publicly.

The drug industry, however, is keenly aware of the change. Makers of drugs to treat obesity, urinary incontinence, epilepsy, smoking cessation, depression and many other conditions are being asked for the first time by the drug agency to put a comprehensive suicide assessment into their clinical trials.

In recent months, the agency has sent letters — it would not say how many — to drug makers requiring that they use such a scale. Merck, Sanofi-Aventis and Eli Lilly are all using a detailed suicide assessment in clinical trials being conducted now.

The seeds for the new federal effort were planted four years ago with the discovery that antidepressants may cause some children and teenagers to become suicidal. Top agency officials at first discounted the finding but commissioned researchers from Columbia University’s department of psychiatry, led by Kelly L. Posner, to reanalyze the drugs’ clinical trials. This work caused the drug agency and its experts to view the risk as real.

Then it received an application for rimonabant, a much-heralded obesity drug developed by the French drug giant, Sanofi-Aventis. As agency medical reviewers pored over the drug’s clinical trial data, they discovered hints that it could cause psychiatric problems, too.

Unsettled by their experience with antidepressants, agency reviewers again mandated the use of Dr. Posner’s system. The assessment found that the drug doubled the risks of suicidal symptoms. In June, an F.D.A. advisory committee voted unanimously that the agency reject rimonabant because of its psychiatric effects, and Sanofi-Aventis withdrew the application although the drug is sold in Europe.

Just this month, the results of a trial of Merck’s obesity drug, taranabant, were published showing similar psychiatric problems. Meanwhile, fears have grown that drugs used to treat epilepsy, seizures and mood disorders may have similar effects. An extensive examination of these medicines by the drug agency should be completed this year.

Suddenly, agency officials realized that multiple classes of medicines might cause dangerous psychiatric problems.

“Clearly we were somewhat surprised when this signal emerged in the pediatric antidepressant data,” said Dr. Thomas P. Laughren, director of the drug agency’s division of psychiatry products. “So various groups within F.D.A. are now looking at suicidality more broadly as a possible adverse event.”

The drug agency’s concerns are consistent with a growing body of research confirming that behavior is heavily influenced not only by genes but also by seemingly innocuous changes in body chemistry. Drugs not reaching the brain were once thought to be largely free of mental effects.

“One lesson from pharmacology is that you can see effects on emotion and cognition without the drug entering the brain if a drug leads to peripheral changes in” other chemicals that enter the brain, said Dr. Thomas R. Insel, director of the National Institute of Mental Health.

Some critics say that the agency’s new-found focus on psychiatric side effects is long overdue.

“The list of drugs that causes psychiatric problems is a very long one,” said Dr. Sidney M. Wolfe, director of Public Citizen’s health research group.

Medicines to treat acne, hypertension, high cholesterol, swelling, heartburn, pain, bacterial infections and insomnia can all cause psychiatric problems, effects that were discovered in most cases after the drugs were approved and used in millions of patients.

Some drugs cause depression so often that doctors prescribe antidepressants prophylactically with them.

Among medicines still for sale, the F.D.A. has determined that the drugs’ benefits outweigh their psychiatric risks. Still, the agency now wants to uncover such problems more reliably and before approval.

There are two reasons that the F.D.A. for years was inattentive to the psychiatric effects of new medicines. First, distinguishing between mental problems that spring from a disease and those that result from its treatment is often difficult. For antidepressants, many researchers suggested that suicidal behaviors resulted because, as patients’ depression lifted, they suddenly had the energy to carry out previous suicidal thoughts.

Second, drug side effects are often first identified in clinical trials when multiple doctors treating hundreds of patients record similar problems in trial notes. But terms to describe depression or suicidal thoughts can vary widely, making them hard to discern.

“The whole spectrum of suicidal thoughts, ideation and attempts is much more difficult to define and study than” other drug problems, said Dr. Eric Colman, deputy director of the drug agency’s division of metabolic and endocrine products.

Indeed, the agency’s initial review of the effects of antidepressants in children was plagued by inconsistent and erroneous observations by investigators. A 10-year-old boy who tried to hang himself was listed only as having a “personality disorder,” an overdose of 11 tablets was called a “medication error” and a girl who slapped herself in the face was labeled as having attempted suicide.

Dr. Posner’s team spent months reclassifying these events as either a suicidal symptom or not. The team created a detailed questionnaire called the Columbia Suicide Severity Rating Scale, now adopted by the drug agency as an often mandatory test to be used in clinical trials.

The last time one medicine’s side effect led the F.D.A. to broadly re-examine its drug approval process was in 1992, when it discovered that Seldane, a popular antihistamine, could cause dangerous heart arrhythmias. Tests revealed other drugs that could affect heart rhythms, and the agency soon mandated that nearly all experimental medicines be tested for heart rhythm effects.

Unlike the Seldane example, however, not every experimental drug program must use the new suicidal symptoms scale. Drug officials said that they looked at a drug’s molecular structure and its effects in animals before deciding whether to insist on the new test.

“That’s where it gets tricky,” said Dr. Colman. “It’s difficult to say where you draw the line.”

But Dr. Posner said in an interview that so many companies and academic research programs were adopting the suicide questionnaire that she was having trouble keeping up with the demand for its use. The questionnaire has been translated into 80 languages, and Dr. Posner has trained scores of teams of investigators from around the world on how to use it. On Jan. 4 she lectured a group of investigators at Yale.

Benjamin A. Toll, an assistant professor in the university’s department of psychiatry, was in the audience and said he planned to use the Columbia questionnaire in a trial almost immediately.

“It’s much more detailed than what we were doing before,” Dr. Toll said. “We used to ask, ‘Are you feeling down? Are you feeling sad?’ ”

Dr. Colman said that the new questionnaire, while important, would not end the uncertainty around suicidal symptoms.

“If a drug makes people depressed but doesn’t make them suicidal, what do you conclude?” he asked. “There will always be some degree of uncertainty.”

Globe Editorial: First, Try To Help

GLOBE EDITORIAL

First, try to help

February 8, 2008

'HE FELL on bad times and turned to the bottle."

"She's meds-seeking."

"He's relapsed eight times. . . . The hospital gave him Percocet."

"He has no problem getting a job when he's sober."

The details of the troubled lives of homeless clients flew quickly in a conversation held last week by a team of counselors, shelter and housing directors, an outreach worker, and a domestic violence specialist all crowded around a conference table in Framingham at the Common Ground Resource Center. It's a weathered and sprawling white house that serves as the first stop for getting housing services from the South Middlesex Opportunity Council (SMOC), an antipoverty agency. The house has the feel of an old railroad station: It's a good place to disembark before one's life veers completely out of control.

The talk is a part of a vital national effort to provide "trauma-informed care," which recognizes how much people can be harmed by addictions and physical abuse.

Two years ago, there probably wouldn't have been much talk at SMOC about the men and women who were failing at saving their own lives, because the situation was stark: Clients who broke the rules were simply kicked out of SMOC's housing.

"It was a lot easier," SMOC's director of planning, Gerard Desilets, says of the old approach.

The only problem was that these people still lived with daily crises. They could end up ricocheting through the public system, going to detox, jails, and other shelters. Family members would cut them off. Some might sleep in cars. And they'd still drink or use drugs and struggle with mental illnesses.

So SMOC changed course, training 400 of its staff members to provide trauma-informed care. And the resource center team was created so that no one staff person would go it alone. The new marching orders were to stop focusing too closely on clients' rule-breaking and reckless behavior, and to be conscious instead of their underlying trauma.

A different approach

The National Center for Trauma-Informed Care (part of the US Department of Health and Human Services) puts it this way: Don't ask people, "What is wrong with you?" But rather, "What has happened to you?"

The devastating answers include domestic violence, child abuse, witnessing violence as a child, and physical and sexual assault. Or it might be that a person has aged out of foster care or left juvenile detention, and suddenly has to build a life out of thin air.

If trauma is severe enough, it can impair people's cognitive, emotional, and physical well-being. With this in mind, the SMOC team keeps talking - about clients and to them; discussing strengths such as who has found housing and a job. When it comes to struggling clients, the team brainstorms about what other staff members or programs might help.

Among the guiding principles: Keep people engaged even if they do break rules, because rule-breaking, relapsing into an addiction, and other self-destructive actions may in fact be clients' attempts to cope with trauma or the result of trauma-impaired functioning.

For those whose lives are fractured by trauma, rhetorical sticks such as "zero tolerance" or "three strikes and you're out" are less likely to work. The words may only seem like so much breath to an adult who is plagued by the demon of chronic childhood beatings.

"We still push sobriety," says James Cuddy, SMOC's executive director. But there's also an effort to help clients understand that some old harmful habits - which might have helped them cope with an assault or chronic childhood abuse - are no longer necessary. SMOC doesn't require clients to reveal traumatic experiences, only to learn the skills they need to heal and function more effectively.

Realism and compassion

Instead of giving up on clients who relapse into addictions, SMOC staffers say "relapsing is part of recovery," and they ask clients, "How can we help you relapse less?"

The work is emotionally draining. Staff members say they invest their hearts and souls. Some are recovering from addictions themselves, so they know, first hand, about this struggle.

Not everyone succeeds. But more of SMOC's clients are achieving stability and independence as SMOC uses trauma-informed care as part of a larger effort to place and keep people in permanent housing.

It can sound like coddling. But Cuddy says it's a matter of treating clients with more respect. He adds that the approach can save money by keeping people out of jail, shelters, and other public facilities.

Trauma-informed care is also championed by the state's Bureau of Substance Abuse Services, which said in a 2006 report that, "While important work has been done both nationally and in Massachusetts to develop trauma-informed integrated care, it is clear that for consumers . . . multiple obstacles remain." Clients need more coordinated care, and more public entities, from courts to state agencies, should be involved.

In the report, the bureau and the Institute for Health and Recovery, a Cambridge nonprofit, (both of which provided technical assistance to SMOC) also pushed Massachusetts to do more to address trauma - by involving law enforcement, helping traumatized parents meet their children's needs, and providing more skilled care across gender, class, ethnic, and other socioeconomic lines.

The bureau already requires the agencies it funds to provide trauma-informed care. And the Department of Public Health is extending the approach to AIDS programs. Federal efforts include a conference in July that's being sponsored by the National Center for Trauma-Informed Care.

It's an effort that should grow. People can be remarkably fragile. And many of the poorest and most harmed don't respond to attempts to flog them into better lives. That's no reason to abandon them.

Mental Health Wards Restrict Access to Email

SPECIAL MENTION 2- Incommunicado: Mental Health Wards Restrict Access to Email (Spare Change News, USA)

Paul Rice
February 5, 2007

People living in certain mental health facilities in Massachusetts are not being afforded access to email, cutting them off from an important conduit of communication with the outside world.

The “Five Fundamental Rights Act,” passed in 1997, was a piece of legislation that guaranteed certain, mostly inalienable rights to inpatients at mental health facilities. These rights include the right to “sealed, unopened, uncensored mail,” as well as postage and stationary, the right to visitors of “your own choosing daily and in private, at reasonable times,” and the right to “reasonable access” to a telephone in order to make and receive confidential calls, and more.

Since the rights were enacted before the Internet was widely accessible, there is no mention of access to what has become the world’s greatest source for information and knowledge, not to mention the cheapest and fastest communication device ever fashioned: email.

Email has become analogous to traditional pen and paper writing, due to ease of use and increasing access to computers. Practically all communication in businesses operates around email, with only more formal or legal documents being held over to the mail system. Anyone who owns or borrows a computer can make a free account through a service such as Yahoo or Gmail. In 1999, researchers determined that 263 million people had an email inbox. Eight years later, with the growth of affordable high-speed connections and reduced price computers with internet access, it is conceivable that the number is nearing one billion.

But when a person enters a mental health facility, although they might have access to written letters and the telephone, administrators are not required to allow access to email and the Internet.

“It’s a huge issue to be cut off from the outside world – being bored out of your mind is not therapeutic,” says Cathy Levin, editor of the Voices for CHANGE Newsletter, a publication from MPOWER, a local mental health advocacy group staffed mainly by current and former psychiatric patients.

“When I was in the hospital, I called my father every night before I went to bed,” she recalls. “It was enormously helpful to feel loved, because the staff doesn’t love you.”

Levin believes that providing access to email should be a right taken as seriously as the telephone or receiving letters.

“This way, you can keep all your balls in play while you’re away.”

One hospital where there is no access to email is the Cahill ward at Cambridge City Hospital. Spare Change News editorial assistant Amanda Morley recently spent a few months at Cahill and found the lack of access to be a point of huge stress. She tells SCN that email would have made her time there much easier.

“It would give me a little sense of companionship, to get messages from people and not feel so alone,” she says. “It boosts your energy and your mood when you get messages from people.”

Morley has four or five close friends whom she only communicates with via email. “Even just a small message really makes a difference.”

As of press time, administrators at Cambridge City Hospital had not returned requests for comment on the issue.

Whether or not advocates inserted language into the “Five Fundamental Rights” about email, an issue may remain with the enforcement of those rights.

“People in psychiatric hospitals have very few rights at all and those rights can be taken away by a staff member instantly,” says Howard D. Trachtman, executive director of the Boston Resource Center at Boston Medical, a peer-to-peer meeting place for people dealing with mental illness issues.

Trachtman is concerned about hospitals’ lack of emphasis on the rights for their patients. “We know anecdotally that they’re very often flouted,” he tells SCN. “They’re not enforceable, and that’s what we’re trying to remedy.”

Jonathan Dosick is another patient advocate who is working on changing the legal text of the Rights to include more actual enforcement at the hospital level. The bill has been introduced to the legislature multiple times over the last few years, failing each time. Advocates are trying again this year, with a new draft.

“Basically, it provides for an appeal process for violations of the Five Fundamental Rights, something that doesn't happen now – generally, DMH complaints filed tend to disappear, or are ‘investigated’ by hospitals,” Dosick writes, in an email to SCN. “However, those at hospitals who are designated as ‘Human Rights Officers’ are, besides employees of the facility, also Risk Managers.”

With a lack of patient advocates (who aren’t employed by the hospital), even if the rights were changed to include email, there would remain no guarantee that the rights would be observed – something which, for people like Amanda Morley, would make all the difference in improving her mental stability.

“Sometimes when I’m walking down the street and there’s a guy panhandling and he tells me to smile, that really helps,” Morley says. “Someone saying something to you is heartwarming. It’s very lonely here and it’s scary because there are 27 people here and I don’t know anyone.” At the new facility she’s lodged at, they recently forbid her from taking her stuffed animals out of her room.

“You may only be in hospital for three days, but in that time you can lose your friends and your job,” says Cathy Levin. “It’s not unlike going into prison and having someone lock the door.”

The difference being that most prison inmates have access to email these days.

By Paul Rice

Reprinted from Spare Change News

© Street News Service: www.street-papers.org

Mental patients find understanding in therapy led by peers

Mental patients find understanding in therapy led by peers

By Carey Goldberg, 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."

Psychiatric patients feel strain

Psychiatric patients feel strain

State investigates complaints at ERs

By Liz Kowalczyk, Globe Staff  |  July 15, 2007

The state investigated at least 21 complaints over the last 18 months that emergency departments mistreated psychiatric patients, and officials cited hospitals in half those cases for problems that included wrongly forcing patients to undress, punching or hitting patients, and restraining others for hours without proper monitoring.

One patient died while in restraints, and a patient's arm was broken as a nurse forcibly removed his pants.

These cases are a sign of the growing strain on the state's overcrowded emergency rooms, doctors, nurses, patients and state officials said, and also reflect a shortage of services for the mentally ill, the challenge of caring for sometimes-aggressive psychiatric patients, and inconsistent training of harried ER staff.

Emergency rooms can be battlegrounds. They often are the last resort for psychiatric patients in crisis -- some patients are so out of control and aggressive that mental health facilities will not take them -- and ERs have responded by creating "safe rooms" to handle such patients and on occasion calling in police for help, according to inter views with 20 doctors, nurses, patients, and hospital administrators.

ER staff give psychiatric medications but are not trained to provide comprehensive psychiatric care, they said. And many of these patients stay in ERs for days without proper treatment because of backlogs in psychiatric facilities, creating potentially volatile situations for those patients, staff, and other patients. Hospital officials said nurses, too, have been injured in confrontations, and patients contend that they are humiliated by policies like the one requiring them to undress.

Patients "will be in the ER from hours to days and they get absolutely no care," said Linda Condon, an emergency room nurse who has worked at four hospitals in Southeastern Massachusetts. "You put a person with psychiatric problems in a room with four walls and nothing to do, and there are going to be problems."

Documents from the Department of Public Health -- which conducts investigations when patients or relatives complain or hospitals themselves report problems -- show that investigators cited 11 hospitals for a range of problems. Those cases include:

A blind, disabled patient who went to Lawrence General Hospital in April because he was suicidal. Hospital policy then required psychiatric patients to undress so that staff could look for hidden drugs or weapons, but the patient wanted to keep on his jeans. A male nurse "used excessive force" to remove them, the health department found, breaking the patient's arm. The patient required surgery and a three-week hospital stay.

In April 2006, a 49-year-old former nurse who arrived in the emergency room at Melrose-Wakefield Hospital at 10:30 p.m., intoxicated and uncooperative. Staff strapped down his arms and legs, gave him sedatives, and assigned a security guard to watch him. After a nurse called the security guard away to help with another violent patient, the first patient had a fatal cardiac arrest. The hospital's internal investigation determined that the patient was not properly monitored. Staff told state investigators that the ER was "very, very busy."

In June 2006, a male teen in the Merrimack Valley Hospital ER in Haverhill began pulling medical equipment out of a wall, kicking furniture, and biting staff. While he was biting a nurse, a staff member repeatedly punched him in the face. State investigators said the hospital did not properly train staff on how to restrain patients. Hospital staff said punching was a last resort because the patient was severely injuring the nurse.

State documents released to the Globe omitted the names of patients and staff for privacy reasons. When health officials find problems during investigations, hospitals must implement plans to correct them.

The state public health and mental health departments have been so concerned about the pattern of complaints that they sent a memo to hospital executives in September, detailing 21 steps they should take to improve care of psychiatric patients in ERs, including reducing waiting times, using trained mediators, and further training staff in techniques to calm patients.

But patients and advocates for people with mental illness say problems remain rampant. They are pushing legislators to increase the mental health department's role in regulating ER care and to require the public health department to develop "best practices" for treating psychiatric patients.

"When we get upset and don't want to take our clothes off, they think we're going to flip out," said Constance Surette, 57, of Plymouth, who has bipolar disorder and works with a group pushing for legislation. "But the way they treat us, of course they're going to get that reaction. The ERs should use peer mediators to talk to [psychiatric patients] because they are frightened of the authority figures."

Surette filed a complaint with the health department last month, alleging that city police officers at Quincy Medical Center sprayed one psychiatric patient with mace and handcuffed another to a bench while she was in the ER. Hospital spokeswoman Janice Sullivan said that she could not confirm Surette's account but that the actions taken were appropriate "for the safety of everyone involved."

Doctors and nurses say they have made improvements but are doing the best they can in an impossible situation. They said the number of complaints statewide is small considering the thousands of psychiatric patients who seek care in Massachusetts ERs each year.

In 2005, ERs reported 168,000 visits by psychiatric patients, 10 percent more than in 2003, according to the Massachusetts Health Data Consortium. And they usually have to wait longer for care. The average ER stay for patients who are eventually sent home or to another hospital is nearly three hours; it's nearly six hours for psychiatric patients. And many of these patients wait two to three days in the ER for an inpatient bed in a psychiatric facility to open.
 

"The emergency departments are overwhelmed," said Dr. Paul Bulat, medical director of the emergency room at St. Luke's Hospital in New Bedford. "We are seeing more violent patients and out-of-control patients. We're seeing mental health problems much worse than we should be."

ER directors are reluctant to acknowledge that overcrowding hurts patient care. But staff told the state health department that busyness was a factor in several of the cases investigated, especially those that involved inadequate monitoring of patients.

In the case of the former nurse who died at Melrose-Wakefield Hospital, not only did the security guard leave the patient alone for about 20 minutes, but the patient's condition was not checked every 15 minutes while he was restrained, as required by hospital policy. Monitoring is especially crucial for intoxicated patients who receive sedatives.

Hospital spokesman Richard Pozniak said he could not comment on the case because of regulations requiring patient information to be kept confidential. State investigators said in their report that 13 patients were in the ER when the man arrived, and 20 other patients arrived before he died 4 1/2 hours later.

Public health investigators also found that lack of training is an issue, including in cases where staff used excessive force. Better training in techniques to calm patients is especially important as frustrated psychiatric patients with no where else to go spend hours in the ER .

In the case of the patient whose arm was broken at Lawrence General Hospital, investigators found a range of problems, including that the hospital's internal investigation of the complaint did not include interviewing the patient. Investigators also found no evidence that staff and security had been trained in patient's rights. And they said the nurse should have explored the patient's reasons for wanting to keep on his jeans before resorting to force.

Hospital spokeswoman Ellen Murphy Meehan said the hospital "expressed deep regret to the patient" for what it considers an accident. She said Lawrence General has since changed its policy to allow some psychiatric patients to keep on their clothes and instead be frisked and scanned with a hand-held metal detector.

Paul Dreyer, director of the state Division of Health Care Quality, said "a culture change" is needed; he is organizing an educational summit for ER staff in the fall, hoping hospitals will improve on their own, making legislation unnecessary. Legislators expect to hold hearings this summer or in the fall.

We want "people to realize they don't have to call in security the first time someone looks at them cross-eyed," Dreyer said. "The ERs are in a production mode. Their aim is to process the patients as quickly as possible to get on to the next patient. These patients may not take well to being treated that way. They may act out."

A number of hospitals said they have improved care after serious encounters.

UMass Memorial Medical Center -- where campus police beat a psychiatric patient with a baton in 2004, injuring him, and, several months later, threw a patient against a wall and called her a "bitch," according to state reports -- said it has made significant changes. These include creating a secured, quiet area for psychiatric patients and training police to use calming techniques. Dr. Patrick Smallwood, medical director for emergency mental health services, also joined the hiring panel for campus police officers last year.

Dr. Bruce Auerbach, chief for emergency and ambulatory services at Sturdy Memorial Hospital in Attleboro, said hospitals need more resources, not more regulation. "When a patient who is having a behavioral health crisis is in my ER for four days not getting the intervention he needs -- it's a travesty in our healthcare system," he said.

Right to fresh air sought for patients

Right to fresh air sought for patients
By Felicia Mello, Globe Correspondent  |  July 8, 2007

It is not much -- just a 6-foot-by-12-foot space with a few chairs, a barbecue, and pots of basil and pink flowers. But to 47-year-old Gigi Alley, the garden she has built on the porch of her Medford home symbolizes everything she did not have during seven weeks of constant confinement in a psychiatric unit at Cambridge Hospital.

"Even in times of real distress, I can find moments of calm just by listening to the wind blow in the trees and seeing squirrels," said Alley, who suffers from depression and multiple personality disorder.

That is the idea behind a bill pending in the Legislature that would require psychiatric hospitals to provide patients like Alley with a right long enjoyed by prison inmates: daily access to the outdoors.

Dubbed the Fresh Air Bill and sponsored by Senator Patricia Jehlen , a Democrat from Somerville, and Representative Frank Smizik , a Democrat of Brookline, the legislation has met with opposition from medical centers and raised questions about the proper balance between patients' autonomy and doctors' clinical judgment.

"It's not that we're against fresh air, it's that we cannot guarantee safety," said David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems, which represents the majority of the state's private psychiatric institutions. "Many patients are in the hospital because they are dangerous to themselves and to others."

Massachusetts Department of Mental Health policy states that all public psychiatric hospitals should allow residents outdoors as long as it is safe.

But the guideline does not apply to the state's 64 private facilities, which range from high-rise, acute-care units in congested urban areas to a working farm in Western Massachusetts where people with severe psychiatric disabilities shovel hay and make cheese.

Consumers of mental health services and their advocates packed a hearing late last month before the Joint Committee on Mental Health and Substance Abuse, which is considering the bill, to make their case that sequestering patients indoors amounts to discrimination. It will be months before the bill reaches the floor of the Legislature -- if it ever does.

"I think in a way this is one of the last frontiers of the civil rights movement," Jonathan Dosick, founder of the Coalition for Fresh Air Rights, said in an interview afterward.

"Psychiatric patients in the larger picture are not being treated with decency and humanity. In our laws, prison inmates are guaranteed time outside per day, and then to have this population of people who are often labeled as violent and unstable and don't enjoy this right really angers a lot of people," he said.

Proponents and critics of the bill differ on how many hospitals would be affected. Matteodo says only two of the hospitals in his group completely ban fresh air breaks.

But many allow them infrequently, only when enough staff is available, or for patients who behave well, smoke, or stay for long periods. Advocates say such restrictions can make it all but impossible for residents to get outside.

"I have talked to parents who are getting calls from an adult child in a psychiatric unit who is told they cannot go outside because they don't smoke," said Dori Hutchinson , director of services for the Boston University Center for Psychiatric Rehabilitation. "Their child takes up smoking just to be able to go outside. To me that's outrageous."

Mary Milgrom, senior director of nursing at Cambridge Hospital, where Alley stayed, said the hospital works to provide patients with fresh air on a case-by-case basis and is currently reviewing its policies.

While few researchers have explored whether being outdoors speeds recovery, many mental health professionals see the idea as common sense -- especially practitioners of ecopsychology, a budding field that examines how the natural environment influences human behavior.

"People without psychiatric conditions seem to cope better and feel more hopeful when they have access to even a small amount of landscaping," Frances Kuo , an ecopsychologist at the University of Illinois at Urbana-Champaign, wrote in a letter to the committee. "Why, then, should people in a more vulnerable state be subjected to an often barren, institutional setting?"

A century ago, wealthy eccentrics flocked to sanatoriums in the countryside to recover from stress, while poor patients spent years on state farms where they got plenty of exercise even as the government exploited their labor.

In recent years, however, advances in medication and shrinking insurance payments have led to shorter hospital stays, usually indoors in urban environments.

With an average length of stay of nine days, some private hospitals argue, fresh air becomes less of an issue.

Administrators worry they will have to construct costly outdoor courtyards for patients, or else parade them through the hospital to reach the street, potentially endangering them and the public.

"We would never want in the name of fresh air to jeopardize a life," said Dr. John Herman , director of clinical services for the psychiatry department at Massachusetts General Hospital.

Those arguments do not convince patients like Alley, who called the unit where she stayed from February to April as insular as a space station.

Even the window blinds were kept closed at all times, she said.

Returning to the outside world was so jarring, she said, that every sound grated on her nerves.

"It's easy to feel freakish and different when you're locked inside," she said. "If I had been able to go out, it would have made me feel less disconnected."

(Correction: Because of a reporting error, a story in the July 8 City & Region section about psychiatric patients being given access to the outdoors incorrectly described state law. A Department of Mental Health policy mandates that state-run hospitals provide psychiatric patients with access to the outdoors if it is safe, but such access is not required by law. All but one of the department's five inpatient facilities have secure outdoor areas for patients.)
 


© Copyright 2007 The New York Times Company
 
  

Who is My "Peer" in a "Recovery Learning Community"?

Who is My "Peer" in a "Recovery Learning Community"? 

Cheryl Stevens MD, R.M.P. (Real Mental Patient – thanks to Jonathan Delman for this designation


As part of a developing recovery learning community in Western Massachusetts, I want to address the whole issue of who among us are our 'peers' and who is/are not our 'peers' but 'allies' or 'partners' instead - people who might have an interest in peer-run services but who do not have a personal recovery experience.  

Mary Ellen Copeland MS, MA refers to people who have been labeled with psychiatric diagnoses as 'key stakeholders' and she designates all other interested people (family, friends, non-peer mental health staff, researchers, policy makers, citizens) as 'stakeholders'.  I appreciate that distinction and I largely agree with it. 


Except that there remains the not-too-small dilemma of those who work in traditional mental health service roles but for whom full-disclosure of our personal recovery histories would place us at risk for further victimization on the jobs (than what we already experience as underpaid and overworked staff).

Before we get too far afield on the theoretical questions of "who is a peer" in the "peer-run" and "peer services" frenzy, I believe in letting each individual decide in their heart of hearts if they have the kind of lived experience that would give them the moral authority to join in our discussions and then letting all interested individuals generate that discussion without too much fretting over who is one of 'us' ('real mental patients') and who is not (then by default, they would be one of 'them' - whomever "they" is/are - wanna be mental patients?!).

These kinds of artificially declared divisions - 'us/them' stuff - are often what happen when we use labels (like "peers") as a communication short-cut which creates categories of people instead of just dealing with people as individuals.  Also, like it or not, the designation of "peer" in front of "worker" or "staff" still carries the oppressive yoke of one who has been labeled. Not everyone who has lived experience in recovery is going to be eager to embrace the mantle "peer"; nor should they have to just to have a seat at our table - which is of course, "their" table too.


I find discussions of these sorts of "boundary issues" about who is '"us" and who is not "us" to be difficult.  


Our boundaries have been repeatedly violated by an overwhelmingly threatening cast of characters that have felt free to parade through our bodies, minds and psyche (souls) – our emotional, intellectual, spiritual, physical, sexual and social boundaries - without any fight from us or any social consequences or sanctions. 


Then in some weird attempt to create a 'safe' place for 'us' to dialogue (as if there were such a thing as a 'safe place' when the source of one's terror has become internalized), we end up creating 'new and improved' labels ("peer") that continue to (inadvertently) exclude - and perhaps oppress - members of our own group!  That is an interesting turn to the cycle of violence! 


Can you see how the violence comes full circle when we internalize the label “peer” to mean a person who experiences psychiatric symptoms?  This is just one more broken identity!  Webster defines peer as “one that is of equal standing with another: EQUAL. 2. (archaic) COMPANION, FELLOW.”   


Whether we suffered childhood traumatic stress/family dysfunction, adult re-enactments of violence ranging from distressing symptoms and addictions to the twisted relations of domestic violence, sexual assault, caregiver abuse and non-trauma-informed psychiatric treatment (psychiatric abuse) by continuing to use the word “peer” to mean someone with a psychiatric history we not only trump all our other past experiences, talents, roles and identities, but we are being (once again) insidiously silenced and co-opted. 


First, we cramp our magnificent Essence into another little label/box that parrots the “master narrative” (to quote Pat Deegan, PhD) of traditional mental health services. We let our distressing experiences (symptoms) or our psychiatric histories define who we are, failing once again to speak the truth about the violence we experienced. 


Second, although some of us have accepted these labels and then turned them around to make them work for us politically, others do not buy into the terminology at all even though they have had the same kinds of experiences as we have – and equally valuable contributions. 


It is an ironic twist that we who have experienced the particular oppression of psychiatric labeling - and all of the doors that automatically close when someone accepts and internalizes these labels - not only corrupt the original meaning of the word “peer” with another broken identity, but then are quick to throw this corrupted label around to define yet another "in" group.  


Now who is doing the excluding? 


This is exactly what happens when we fail to speak the truth about violence – it gets re-enacted as the “victims” re-victimize themselves and/or go on to perpetrate the same kind of violence against others.   


Our boundaries have been so thoughtlessly trampled upon again and again by the very people we trusted, do we dare trust ourselves and one another without the use of a “code word” – peer – to define (limit) us??? 


In this way, the "peer/non-peer" issue becomes yet another opportunity to either re-enact the cycle of violence or to transform our past trauma by "doing it differently" - set ourselves and one another free.

Such semantic conflicts have ended up hurting (disabling) the “consumer/survivor/ex-patient (c/s/x)” movement, by co-opting us into spearheading some kind of  Psychiatric Reformation rather than keeping our original focus as a human and civil rights movement to end psychiatric violence (“treatment”). 

I belong to the Staff Survivors Network (www.staffsurvivorsnetwork.com). We are c/s/x people who work in traditional mental health services - in either peer or non-peer designated roles – to speak our truth (“until we get sick and have to quit or until we make them sick and they have to fire us” to quote Jackie McKinney).  


Having been oppressed by the effects psychiatric labeling, my “post- recovery” transformation requires me to help others who are still stuck in services (on either side of the paycheck) in addition to my social action (political transformation). I am then an “enlightened witness” raising awareness among people receiving services and speaking my truth to power – a natural role for me given my lack of social skills - I am as "reactive, confrontational, unapologetic and inconvenient" as the MPOWER T-shirt declares me to be - even inappropriate, too


My point is that there are those among us who still work in these oppressive roles in the system trying to do our part in easing the burdens of those who are still caught up in it. Some are (appropriately) not comfortable disclosing our personal experiences on the job, but might seek to have a role in a recovery learning community in off-hours....do we have room for such internal change agents without checking their R.M.P. (‘Real Mental Patient) credentials or asking them to blow their 'cover' in their day jobs?

If not, then why not? 


Our movement should not exclude c/s/x’s who work in the system nor should we insist that they “out” themselves if I they have not widely disclosed their past on the job or to supervisors.  


Although it might be a crude parallel - and I do not wish to offend anyone - I am reminded that many people worked for the resistance throughout Europe during Nazism, not just individuals of certain targeted groups.  Schindler and other righteous people were not Jewish, gay, 'mentally defectives', intellectuals, artists, activists, etc. but were 'ordinary' German or French or Italian or English citizens (at least they didn't trigger the radar of the Nazi's) who could no longer remain silent and be another complicit cog in the oppressor's machinery.  Their strategic influence depended on them NOT being on the radar!

I say that as a recovery LEARNING community, we make a decision to DO IT DIFFERENTLY. Let’s be a haven for ANYONE who feels like they are an individual - perhaps a round peg in a square hole - who can no longer participate in the cruel charade we call “treatment” (non-trauma-informed services/system) as perpetrated by a naked emperor (psychiatry).


Before we define who "we" are as a peer community of people interested in building peer-run recovery-oriented services, I suggest that we open up the tent and see/learn who comes in.  Then we can be in a better position to meet one another and learn who we are - each one of us.  


Then maybe we won't have to create another category or label that people have to fit into in order to join the discussion.  We will be able to define who "we" are and exactly what we mean when we say something like "peer-run" because we will have forged respectful and mutually responsible (trauma-informed) working relationships with one another – something that people in traditional service systems fail to take the time to do, leading to continued traumatic repetition compulsions of the cycle of violence - further disabling (silencing) clients and staff alike.  


We don’t have to be a parody of the mental health system by forcing members of our movement to adopt or to remain in oppressive little boxes (“peers, staff, clients, consumers, survivors, ex-patients, activists, service-recipients…”) which victimize one another and maintain the silence about the effects of childhood traumatic stress – growing up with neglect, physical, emotional and sexual abuse including incest; growing up in a home affected by alcoholism, “mental illness”, the loss of a parent;, someone who was incarcerated, or seeing your mother hit even just once (see www.acestudy.org for details on the effects of childhood trauma on various health indices of the U.S. adult population).

I didn't climb out of one box to be put in another one, especially one that is self-defined and self-directed.

Recovery Network News: E-newsletter of the Transformation Center

Recovery Network News E-newsletter of the Transformation Center  Monday, February 18, 2008   Creating connections between people in mental health and addictions recovery through peer support, training, education and advocacy.   Please forward this email to distribute this information as widely as possible and also please share the information with people who do not have email. To receive this weekly e-newsletter, please click on the "Join Our Mailing List!" button at the bottom of the screen. Choose the option for "General Interest." New News is Good News   Starting today, Recovery Network News will come out weekly on Monday afternoons! Please contact Melissa Sances with any new job opportunities or activities that you'd like to advertise at 617-442-4111 or melissa@m-power.org. (Note the permanent change in address; please use newsletter@m-power.org regarding Voices for Change issues only. Thanks for being patient as we work out all the finer details!) You Don't Want to Miss This! Be sure to read the entire newsletter for (in this general order) community news, Guiding Council meetings, an overview of what's happening at the RLCs, community activities, upcoming trainings and conferences, and many fantastic job opportunities!   Sad News Community Loses Active Member and Friend, Shelley Bowen Support available at The Transformation Center and in Western Mass Dear Peer Community, We are very sorry to have to share that one of our friends and peers, Shelley Bowen, passed away unexpectedly last weekend.  Shelley had been very involved in the Western MA Recovery Learning Community and Guiding Council over the past year, participated in several classes and workshops, and had recently begun facilitating WRAP trainings at the Holyoke Resource Connection Center. She had taken many great strides in her life, and it was with pride that she openly shared how important WRAP, becoming a Certified Peer Specialist, the RLC and her friends all over the state had been in that process.   Even though Shelley lived in Pittsfield, her presence was well known at M-POWER and The Transformation Center in Boston where for the last year she came biweekly to our Boston office for WRAP facilitator mentoring with incredible hugs and smiles for all. She touched our lives with her presence and example and was a friend to many. Though these individuals can not be available at all times or days, the people listed below will do their best to respond to any calls received as soon as possible: 1. Marina C. (MASSWRAP and The Transformation Center): 617-442-4111 2. Kerrie F. (MASSWRAP and The Transformation Center): 617-442-4111 3. If you would like to speak to anyone at the Western MA Recovery Learning Community, their main number is 413-539-5941 x200.   Fit to Guide: Join your Local RLC's Guiding Council Recovery Learning Communities are peer-led communities of support for mental health and/or addictions recovery. The Guiding Councils are the advisory committees of these organizations. Below are the Guiding Councils' upcoming meetings by region. Meetings are open to all.   MetroSuburban              Wednesday, February 27, from 11 a.m. to 1 p.m., Quincy Mental Health Center, 460 Quincy Avenue, 4th Floor Conference Room, Quincy. Contact 617-472-3237 or info@metrosubrlc.org.   Central Mass   Thursday, February 28, from 5 to 7 p.m., Recovery Learning Center Office, 91 Stafford Street, Worcester. Contact 508-751-9600 or centralmassrlc@yahoo.com.   Happening Places to Be: What's Going on at the RLCs There is so much going on at each Recovery Learning Community that we can't list everything here! Below are a few highlights; please contact each RLC directly for more information. Western Mass Starts Trauma Group February 27 866-641-2853 or oryx@westernmassrlc.org Are you a man who has experienced trauma in your life? Join facilitator Mabella Mendez for an ATRIUM (Addiction and Trauma Recovery Integration Model) group for men, where participants will work on better understanding how their trauma histories are connected to their self-harming and/or self-destructive tendencies, and will also work on learning new approaches to coping. The group will take place at the Holyoke RCC, 187 High Street, Suite 303 and is scheduled to start on Wednesday, Feb. 27. Applications are required (due February 19). Space is limited. Please call 866- 641-2853 x200 with questions or for an application.  Actual start date will depend, in part, on numbers signed up. WHAT IS ATRIUM:  ATRIUM stands for Addiction and Trauma Recovery Integration Model and was created by Dusty Miller.  The acronym is intended to suggest that these groups are a starting point for healing and recovery.  The ATRIUM model is directed at bringing together peer support, psycho-education, interpersonal skills training, meditation, creative expression, spirituality, and community action to support survivors in addressing and healing form trauma. Central Mass to Offer Recovery Story Workshop 508-751-9600 or centralmassrlc@yahoo.com Do you want to inspire hope in others? Do you want to share your experiences and strengths? Then the Recovery Story Project is for you. Come find out how to become a recovery speaker and share your journey toward wellness with others. This workshop will offer guidelines for developing  your story and how to get started as well as practical steps to being ready to share your story. There will also be an opportunity to hear other seasoned speakers share their stories and experiences. No sign up required. The next workshop is Friday, Feb. 29 from 3 to 4:30 p.m. at the Recovery Learning Center Office, 91 Stafford Street, Worcester. MetroSuburban Holds Ongoing Peer Support Group 617-472-3237 or info@metrosubrlc.org The MetroSuburban Recovery Learning Center is forming a book club for consumers to read and discuss the published works of consumers/survivors. We would like to explore what helped and hindered their recovery and how the system is the same or different today. Join us every Monday from 3:30 to 5:30 p.m. at the MetroSuburban RLC, located at the Quincy Mental Health Center, 460 Quincy Ave, 2nd Floor, Activity Area B, Quincy. If you have questions, or to RSVP, call Melissa at 508-269-2807 or e-mail melissa877@hotmail.com. Just for Laughs Laughter Yoga at MDDA-Boston - Next Meeting March 5, 2008 Laughter Yoga is a form of physical exercise that combines simulated laughter along with gentle yoga breathing techniques and stretching as a way to improve an individual's health and happiness. It's a great aerobic workout, yet gentle on the body. Anybody can do it and it is fun! Free Laughter Club meetings are led by Judy Ho, a certified Laughter Yoga Leader and MDDA-Boston Facilitator on the first Wednesday of each month, before MDDA-Boston Share/Care Group meetings. The next meeting will be on Wednesday, March 5 from 6:30 to 7 p.m. at the deMarneffe Cafeteria at McLean Hospital, Room 117, in Belmont. Contact Judy Ho with questions or concerns at laughterhealer@gmail.com. Low-Pressure Acupuncture Pathways to Wellness Offers Low-Cost Acupuncture Group sessions Mondays, Thursdays and Saturdays; other discounts available  Acupuncture is an Asian medical technique that developed more than 3,000 years ago in China. This ancient medical system has proved invaluable for people living with chronic illness. Regular treatments help boost the immune system, prevent infections, and maintain energy. Our new Low-Cost Acupuncture Treatment is provided in a unique traditional acupuncture setting that utilizes a group treatment healing experience. Up to four people will receive treatment at one time in a group treatment room. Our new sliding scale rate is $20 - $35 per one-hour session; open to all regardless of income level. Pathways also serves as a teaching clinic for students at the New England School of Acupuncture (NESA) Masters' Program and trains top specialists. Through NESA we run an Intern Acupuncture Clinic that provides treatment on Thursdays for a discounted fee of $20. Pathways is located in Boston's South End, at 1601 Washington Street, 3rd Floor. To make an appointment, call 617-859-3036 or visit www.pathwaysboston.org.   That's a WRAP! Upcoming Wellness Recovery Action Plan (WRAP) Trainings Next MetroSuburban orientation March 5; contact Central Mass for upcoming dates WRAP, a program developed by Mary Ellen Copeland, offers another way to deal with life's challenges, including mental health issues. WRAPs are written by the experts: ourselves. WRAP helps us learn more about what we need to do on a daily basis to maintain or regain our wholeness, how we take care of ourselves and what triggers us. In a WRAP, we explore ways to help maintain or recover our wellness. MetroSuburban WRAP classes Weekly classes will be held at The Edinberg Center, at 169 Elm Street in Waltham. A one-hour orientation to WRAP will be held on Wednesday, March 5 from 6 to 7 p.m. If you're intrigued, sign up for the 10-week WRAP sessions, beginning Wednesday, March 12 from 6:30 to 8 p.m., with support & tutoring offered until 8:30 p.m. Registration is required to attend! For more information or to register, contact Scott Wennerberg at 617-472-3237. Central Mass WRAP classes Current classes are held on Wednesdays at Worcester State Hospital from 10 to 11:30 a.m. and at the Recovery Learning Center office, 91 Stafford Street, Worcester from 1 to 2:30 p.m. These classes are currently closed to new participants. Call to find out when the next series will be offered: 508-751-9600. For more information on Mary Ellen Copeland and WRAP, visit mentalhealthrecovery.com.  Holy (Healthy) Smokes! Free Smoking Cessation Specialist Training Healthy Changes Initiative training from March 10-11 in Lowell, MA; four slots left! We at Healthy Changes Initiative are very interested in having consumers work in DMH and community setting help motivate everyone and help support people who want to quit smoking. On Monday, March 10 and Tuesday, March 11 we will hold an all-day training in Lowell for people who have lived experience with mental health issues (and don't smoke currently) to start the path towards becoming licensed Smoking Cessation Specialists. If you are interested, please contact Rachel Klein as soon as possible at 617-393-3930 between 8 a.m. and 5 p.m. or 617 926-7177 between 8 a.m. and 9 p.m. E-mail Rachel at rachelaklein@rcn.com. This course is usually $125, but is being offered for FREE to six peers! Four slots are left. Upon completion of the training and supervision/working for a certain number of hours, this is a Medicaid-reimbursable job! We expect there to be jobs available in all DMH areas for peers to work with people inpatient and in community settings. Peer facilitators, CPS preferred but not necessary for this wonderful opportunity. Please spread the word in all ways you can! If you cannot come to this workshop, due to location or date, please contact me if you are interested. There may be future training opportunities in Springfield and SE DMH areas. Just for Fun(ds) L.O.V.E. Fundraiser on Wednesday, February 27 in Methuen On Wednesday, February 27, 2008 the Lawrence Organizing Voices for Empowerment (the L.O.V.E. Group) will hold a fundraiser at the new Methuen Fuddruckers, 436 Broadway/Rt. 28 (at the Village Mall). Dinner and a raffle (open to families!) will be held from 4 to 8 p.m. Organized by the L.O.V.E. Group and the Northeast Independent Living Program, a portion of all sales will go to the L.O.V.E. group and its advocacy efforts. For more information, call the Northeast Independent Living Program at 978-687-4288 or call Fuddruckers at 978-685-9300.   Forward Movement: Health Care for All Conference "Building Momentum, Moving Forward" 3/28 in Boxborough www.hcfama.org/conf08 Health Care For All's annual Policy and Organizing Conference will be held this year on Friday, March 28 at the Holiday Inn, Boxborough, located at 242 Adams Place in Boxborough. This year's theme will be "Building Momentum, Moving Forward." Come meet and hear from the lawmakers, community leaders, business leaders, and organizers who are working to make affordable, quality health care for all a reality in Massachusetts! For more information about the conference or to register, click the above link, e-mail hcfaconferenceinfo@hcfama.org or call 617-275-2934.   Work your Recovery: Exciting New Peer Position at DMH   40-Hour/Week Patient Liaison Position at Taunton State Hospital www.mass.gov/dmh The Department of Mental Health, as the state mental health authority, assures and provides access to services and supports to meet the mental health needs of individuals of all ages, enabling them to live, work and participate in their communities. The Department establishes standards to ensure effective and culturally competent care to promote recovery. The Department sets policy, promotes self-determination, protects human rights and supports mental health training and research. This critical mission is accomplished by working in partnership with other state agencies, individuals, families, providers and communities. We are looking for someone with LIVED EXPERIENCE to work a 40-hour/week position as a Patient Liaison at Taunton State Hospital. For more information on the Patient Liaison position, go here. Duties will include: ·       Working with patients and staff to ensure a participatory process for patients as it relates to the Principles of Recovery such as empowerment, responsibility, instilling hope, wellness and strength-based care. ·       Supporting the hospital initiative to reduce and eliminate restraint and seclusion. ·       Supporting and enhancing the integration of the Recovery Model with all aspects of clinical care in collaboration with the clinical departments and advocating for the patient in the treatment planning process. ·       Acting as co-leader of the Patient Empowerment Committee, and, in collaboration with the Rehabilitation Department, providing oversight of the Recovery Resource Center. IMPORTANT TO NOTE: People need not lend too much importance to the qualifications required relating to "investigatory or law enforcement" experience. Other experiences, knowledge and skills may be equally important. To apply, send a cover letter and resume to healthhr-customerservice-se@state.ma.us or fax them to 508-977-3588. Candidates who do not have a resume can complete an Employment Application at the below address. Any questions, contact our customer service unit via the above e-mail or by calling 508-977-3120 or 508-977-3280. Mail cover letter and resume to: EOHHS/Human Resources PO Box 4007 60 Hodges Ave.,Ext. Taunton, MA 02780 Posting ID #J13729 Work your Recovery: Jobs at the Transformation Center Peer Specialist Program Coordinator and Latino Peer Support Network Project Director www.m-power.org, www.transformation-center.org   The Transformation Center is an organization run by and for a diverse community of people with mental health conditions, including those of us with co-occurring addictions recovery needs.  We are building an organization that will help the community fully and respectfully welcome people with psychiatric conditions, find out about mental health recovery, learn practical leadership skills, learn about the role of a Peer Specialist in mental health services, increase the transformative impact of peer-operated services, and advocate for realistic solutions in mental health and addictions policy.    We are currently seeking a 40-hour/week Peer Specialist Program Coordinator. For more information about this position, go here. We are also seeking a 32-hour/week Latino Peer Support Network Project Director. For more information about this position, go here. To apply, send resume and cover letter to: Ann Stillman - Administrative Coordinator M-POWER & The Transformation Center 98 Magazine Street Roxbury, MA 02119 617-442-4111; ann@m-power.org   Work Wonders: Jobs at South Shore Mental Health   Jobs Range from Part-Time Peer Mentor to Full-Time Life Coach www.ssmh.org South Shore Mental Health is a private, non-profit comprehensive behavioral healthcare organization providing mental health and substance abuse services for people of all ages throughout Southeastern Massachusetts and Cape Cod. Our continuum of services includes outpatient counseling, medication, intensive outpatient programs, early intervention, day treatment, residential services, twenty-four hour emergency services and crisis stabilization. We are seeking to fill many full- and part-time positions; below is only a highlight of what we have to offer! For more information on all positions (and more!), click here and scroll down to the applicable bolded position. PEER MENTOR-QUINCY-20 HOURS/WEEK We are seeking a 20-hour/week Peer Mentor in our Supported Employment Program in Quincy. The Peer Mentor Program helps transitional age young adults in the Southwest Suburban Department of Mental Health Area (Canton) and the South Suburban Department of Mental Health Area (Quincy), ages 16-25 who have been diagnosed with mental illness. LIFE COACH - QUINCY - FULL-TIME - 01/28/08 Unique opportunity exists for a full-time Life Coach to act as a mentor to children and adolescents ages 7 to 18 in our Foundations program! The Life Coach works with individuals 1:1 and in small groups and is responsible for facilitating social integration, teaching social skills, accompanying them on trips out into the community, and discovering and engaging them in hobbies and fun activities. All in a Day's Work: Gould Farm Offers 40-Hour Position Apply by Feb 22 to Work as a Resource Coordinator in Boston www.gouldfarm.org   Gould Farm (The William J. Gould Associates, Inc.) in Monterey, MA and its transitional program in Medford, MA, comprise a psychosocial rehabilitation program with strong roots in the traditions of social service and fellowship.  A compassionate and respectful residential community where people with mental illness learn to build more meaningful lives for themselves, Gould Farm provides a solid clinical, work and community program that offers a wide range of opportunities for people to address their individual goals.  Gould Farm is currently seeking a 40-hour/week Resource Coordinator. Reporting to the Clinical Program Director of Gould Farm's Boston Area Programs (BAP), the Resource Coordinator is responsible for connecting with the wider community through networking and seeking out potential paid employment, volunteer, educational and affordable housing and benefit opportunities for BAP participants. The Resource Coordinator acts as consultant and advisor to BAP participants and staff to communicate those opportunities. The Resource Coordinator provides a consistent presence and advocacy for residents and Extended Community members (clients) by encouraging, promoting and facilitating growth toward greater independence. Candidate must have a BA in social work or related human services field or equivalent with two-four years experience or training in a related field; Masters Degree in vocational counseling preferred. Knowledge of mental illness and recovery with respect to the complex effects on different demographic groups including relevant area resources and the benefits system is desirable. Excellent networking, verbal and written communications skills are essential. Willingness to promote the values and spirit of Gould Farm, to actively participate as a member of the community and to continuously seek ways to improve, both self and function. Gould Farm is an equal opportunity employer and offers a comprehensive health insurance package at a minimal cost to employees as well as dental insurance which is fully paid by us. In addition, we offer paid vacation, sick, short term disability and holidays. To apply, e-mail resume and cover letter by February 22 to hr@gouldfarm.org or mail to Human Resources, Gould Farm, P.O. Box 157, Monterey, MA  01245-0157. Work It: Two Openings at Riverside Community Care Employment Specialist and Peer Support Program Coordinator  www.riversidecc.org Riverside Community Care is an award winning, non-profit organization that helps build healthy communities by providing "the help you need close to home." At Riverside, we have worked for more than four decades to build a healthcare and human service system that enables individuals and families to continue to live in their own communities, even when facing daunting challenges. Riverside Career Services, a Riverside Community Care SEE (Services for Education and Employment) program located in Melrose, MA is currently seeking applicants for a part-time Employment Specialist. Responsibilities include job development, resume writing, on-going job support, anti­-stigma education, benefits counseling, and more general advocacy on behalf of adult mental health service users. The Employment Specialist will work weekdays with some flexibility in how the 20-hour/week schedule is set up. A lived experience of mental illness is strongly preferred.For more information about this position, click here or contact Marjorie Longo at 781-662-0316. Riverside Community Care's Peer Support Program is seeking a part-time Program Coordinator to oversee all aspects of the program's operations; work independently to hire, train and offer guidance to peer support workers; match peer support workers with consumers; comfortably interact with DMH representatives, Riverside staff, and other providers; and participate in agency committees.The ideal candidate is a Certified Peer Specialist or an individual with a lived history of recovery in the context of mental illness who has participated in a recognized training to provide services that promote wellness and recovery.  This position is for 20 hours/week; hours will be primarily M - F daytime hours, with some flexibility required to accommodate meetings. For more information on this position, click here. To apply for both positions, mail, fax or e-mail a resume and cover letter to: Human Resources, Riverside Community Care, 450 Washington Street, Dedham, MA 02026; fax 781-320-3603; or e-mail jobs@riversidecc.org. Keep Workin' It: Part-Time Opening at Potter Place   20-Hour/Week Food Services Position Available www.potterplace.org Potter Place, located at 15 Vernon Street in Waltham, is hiring a 20-hour/week assistant work area coordinator in food services. Contact Mark Maragnano at 781-894-5302 and/or MMaragnano@potterplace.org.   Our Next Recovery Network Newsletter   Look for our next newsletter on Monday, February 25! E-mail Melissa Sances at melissa@m-power.org or call 617-442-4111 with listings.     Melissa Sances Recovery Network News melissa@m-power.org
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Upcoming Events

• Central MA Recovery Learning Community
• New Men's Trauma Group (ATRIUM)
• Transformation Center Training Calendar

Central MA Recovery Learning Community

February Events Wellness Wednesdays   Wed. February 6, 2008 4:30-6 pm at RCC Expressions of Hope and Joy! After a wildly successful first run, this exciting and invigorating Wellness Wednesday returns to the Central MA Recovery Learning Community for a second round. What's it all about you ask? The answer is .....what are YOU all about? How do you express your joys, your hopes? What is your creative outlet? Singing? Music? Poetry? Dance? Art? Bring your favorite music, poetry, songs, stories, pieces of art, including originals of course and share with the group. Come and let your creative side flow and join us for a fun filled and restorative evening! No sign up required. Wed. February 20, 2008 4:30-6pm at RCC Piecing Together Poetry Have you ever seen magnet poetry? You know ... when there are bunches of words on magnets and you piece them together in a way that is meaningful to you .. that's what piecing together poetry night is all about. No need to bring anything, just your openness to exploring the possibilities of your creative potential. Discover the poet in you ... so come and enjoy where the words lead you, you may be surprised by what they have to say! No sign up required. Coffee Hour Tuesday, February 12, 2008 10:30-11:35 pm at RCC What is better than a hot cup of joe and some nice conversation? Come on down to the Resource Connection Center (91 Stafford St) and spend time with other folks who want to share thoughts and support each other. This is a great way to get to meet other people who are part of the RLC and find out what it is all about. And don't forget the best part, the coffee is FREE! No sign up required. Maximize Your Income Introduction Thursday, February 21, 2008 5-6pm at the RCC This is a one hour introduction to a five week course on taking control of your fiances! The course will cover topics such as cleaning up your credit history and how to increase your income and still keep benefits intact. Information learned during this series can help you become an advocate for others. Come check it out and see what it is all about! Call the RCC (508) 751-9600 to sign up today! Friday Nite Live!!!! February 29, 2008 5:30-8pm at RCC Are you bored? Lonely? Don't spend another Friday night alone!! Join your peers for a fun filled evening of conversation, games, blockbuster movies, poetry readings, etc. .... Call to find out what will happen this month (508) 751-9600. Refreshments will be provided! No sign up required. WRAP (Wellness Recovery Action Plan) Wednesdays - Worcester State Hospital 10-11:30am, RCC 1-2:30pm WRAP works! It has been developed by a group of people who experience mental health difficulties. These people learned that they can identify what makes them well and then use their OWN wellness tools to relieve difficult feelings and maintain wellness. The result has been recovery and long-term stability. Your WRAP program is designed by you in practical, day-to-day terms and holds the key to getting and staying well. It does not necessarily replace traditional treatments and can be used as a complement to any other treatment options you have chosen. From Mary Ellen Copeland's web page mentalhealthrecovery.com. These classes are currently closed to new participants. Call today to find out when the next series will be offered! (508)751-9600 Recovery Story Project Workshop Friday February 29, 2008 3-4:30 Do you want to inspire hope in others? Do you want to share your experiences and strengths? Then the Recovery Story Project is for you. Come find out how to become a recovery speaker and share your journey toward wellness with others. This workshop will offer guidelines for developing your story and how to get started as well as practical steps to being ready to share your story. There will also be an opportunity to hear other seasoned speakers share their stories and experiences. No sign up required. Guiding Council Meetings Thursday, February 14, & 28, 2008 5-7pm The Guiding Council is a group of individuals from the recovery community in Central Mass that act as advisory board to the RLC. This group has provided the RLC wtih excellent direction and guidance in bringing this community together. Want to know more or learn how to join the Guiding Council? Give us a call (508) 751-9600. No sign up required. Volunteer Orientation/Training Monday, February 25, 2008 10-12pm at RCC Find you have some time on your hands? Interested in helping out and using your skills to further the peer movement? We are looking for you! Why not help out and volunteer at the RLC. We are looking for people who want to share their strengths and talents and help this community grow. The volunteer orientation training is a two hour introduction to the RLC including an overview of hospitality, the history of the RLC, an introduction to trauma informed care and much more. Call today to sign up (508) 751-9600!

Central Mass Recovery Learning Community 91 Stafford Street Worcester, Massachusetts 01603 508 751-9600

New Men's Trauma Group (ATRIUM)

Are you a man who has experienced

trauma in your life?

Join facilitator Mabella Mendez for an ATRIUM group for men, where participants will work on better understanding how their trauma histories are connected to their self-harming and/or self-destructive tendencies, and will also work on learning new approaches to coping.

Tentative Start Date: Wednesday Feb. 27, 2008, 2:30-3:30pm 

Location: Holyoke RCC, 187 High St, Suite 303

Applications required (due February 19). Space limited. Please call (866) 641-2853 ext. 200 with questions or for an application. Actual start date will depend, in part, on numbers signed up.

WHAT IS ATRIUM?: ATRIUM stands for Addiction and Trauma Recovery Integration Model and was created by Dusty Miller. The acronym is intended to suggest that these groups are a starting point for healing and recovery. The ATRIUM model is directed at bringing together peer support, psycho-education, interpersonal skills training, meditation, creative expression, spirituality, and community action to support survivors in addressing and healing form trauma

The Western Mass RLC aspires to be fragrance free. Sign language interpreters available upon request. Please avoid scented products while at the RCC. The RCC is wheelchair accessible.

Transformation Center Training Calendar

Spring 2008
February 18	DHOH WRAP	Boston
February 23 RESHCEDULED:           NEW DATE - MARCH 8	Peer Facilitator Training	MetroSub RLC
March 9 – 14	WRAP Facilitator Training	Westfield (Sorry, CANCELLED)
March (20 – 28 ?)	NCTIC – Trauma Informed Care Planning Retreat	Details TBD
March 10	Integrating Peers – Larry Fricks	Holyoke
March 12	Integrating Peers – Larry Fricks	Worcester
March 14	Integrating Peers – Larry Fricks	Boston
March 17	Integrating Peers – Larry Fricks	Bedford
March 19	Integrating Peers – Larry Fricks	Brockton
March 22	Peer Facilitator Training	Central MA RLC
March 28	DHoH WRAP Training	Worcester
March 30 thru April 9	CPS Training	Yarmouth, Cape Cod
April ?	DHoH WRAP Training	Location TBD
April 19	Peer Facilitator Training	Boston
May 9 thru 17	CPS Testing	Location TBD
May 11 thru May 21	CPS Training	Yarmouth, Cape Cod
May ?	DHoH  WRAP Trainning	Location TBD
June (first week)	Restraint & Seclusion Summit	Location TBD
June 20 thru July 2	CPS Testing	Location TBD
June 24	CPS Recognition Event	Statehouse
July 8 thru 16	CPS Testing	Location TBD
June ?	DHoH WRAP Training	LocationTBD
May 21	EMPOWERED! at The Statehouse	Members’ Room, Statehouse

Voices For CHANGE Newsletter

VFC is pleased to represent the diversity and strength of the Recovery Movement in Massachusetts. We are consumer-operated. We publish news, views, personal recovery stories, poetry, photographs and drawings. The newsletter comes out between four and six times per year.  



 

      Please send submissions for consideration to

          Cathy A. Levin, editor

                              98 Magazine Street

                              Roxbury, MA 02119

                              Fax: 617-442-4005

                              cathy@m-power.org 
 


Authors receive $30 payment for each article. There is no budget for poetry and artwork, but you’ll get credit. Deadlines are six weeks before publication. Contact editor, Cathy A. Levin to find out the deadline for the next issue at 617-442-4111 x 360 or newsletter@m-power.org.


Our mailing list contains about 1,200 names. About 200 copies of VFC are mailed to clubhouses. An additional 100 copies are given away on information tables at events. About another 150 copies are provided to partner organizations, such at the MDDA and the Metro Boston Resource Center. VFC is also available at the M-POWER/Transformation Center office.  


Voices for CHANGE is free for those for whom it is a hardship to make a donation. For those with greater means, a donation is gratefully accepted. To have your address added to our mailing list, please contact Ann Stillman at 617-442-4111 x 301, ann@m-power.org or send your check to Ann Stillman, 98 Magazine Street, Roxbury, MA 02119. To remove your address from the mailing list, also contact Ann Stillman.

Click here to veiw the article titled "What Helped in my Recovery"

Click the following link to view the archives 

Archives

These are back issues of the Voices for CHANGE newsletter

issue 11.pdf
issue 12.pdf
issue 13.pdf
issue 14.pdf
issue 15.pdf
issue 16.pdf

Articles

It is best if your writing is typed in Microsoft Word, Works or WordPerfect, and also in Times New Roman, 12 pt type, single-spaced, with standard margins, and only one space after periods. Please send your articles as email attachments to newsletter@m-power.org. As some people don’t have email, we also accept articles by mail and fax. Mailing address Editor, Voices for CHANGE, 98 Magazine Street, Roxbury, MA 02119 or fax 617-442-4005.

Artwork

The M-POWER/Transformation Center office has a scanner to convert drawings and photographs into digital images for use in the newsletter, in case you cannot email them.

Authors

The best length of articles is one page. That is about 500 words, a length that fits neatly into Microsoft Publisher as a two-column article. That length means we can include a photo of the author or a graphic design. We must limit articles to 1,300 words, so that more writers have a chance to be published. Our editors are skilled in trimming work in order to reduce the length for publication. They can also smooth out rough work and correct puzzling grammar or structure. Let us work with you to produce writing of polish and excellence.

Consumer Operated

Approximately five editors are working on the editorial committee of VFC. They are responsible for editing two-to-three article per issue, and also proofreading. Editors are also contributors. They are often asked to produce news articles about events and programs of M-POWER/Transformation Center or to turn newspaper reports into short articles or to write articles from notes. Editors work hard. They receive a stipend of $100 per issue for editing, in addition to $30 per article they write.

Diversity and Strength (Mission Statement)

Martin Koehler & Cathy A. Levin 
 


The mission of Voices for CHANGE, the newsletter of M-POWER is to inform, educate and inspire. 


• To inform our readers with a forum for memoirs, opinions and ideas.
• To publish stories about people’s own struggle to recover from psychiatric disability.
• To empower people to build meaningful lives on the ashes of trauma.
• To provide information on policy decisions, programs and opportunities within M-POWER and the Transformation Center.
• To educate our readers about the thinking of national and local leaders in the recovery movement.
• To educate consumer/survivors about our rightful place in the social system, and about civil rights and entitlements.
• To inspire people by an awareness of our potential power by featuring the work of author’s who have made something of themselves.
• To inspire persistence in the face of stigma, bigotry, discrimination, pessimism, helplessness and political defeatism.  
• To inspire self-esteem through role models among our peers in the movement.
• To advocate politically, both individually and as members of an oppressed class of people.
• And, most of all, to cheer on and applaud for non-traditional paths to achievement and success.
Voices for CHANGE solicits and encourages submissions from the public. We are looking for a variety of articles and poetry, drawings, photographs, cartoons, and letters to the editor. Please join us as readers, as contributors, or both, as we strive to pull together the diverse strands that make up M-POWER and the Transformation Center.

Editor Cathy A. Levin

The editor is Cathy A. Levin. She has academic credentials of a BA from the University of Maryland (1995), a certificate in Writing from University College at Northeastern (2004), and a graduate certificate in Women in Politics & Public Policy from UMass Boston (2005). She is also a graduate of the Consumer Provider Program at C.A.S.C.A.P. (2000) and the Mass Leadership Academy at M-POWER/Transformation Center (2005).