A Look Backward/A Look Forward — Lilly Reintegration Awards 10th Anniversary
Wanted: An Agreed-Upon Model for Recovery
Education
Connecting Dots
What the Reintegration Award Winners Recommend
"We're working in isolation from each other. How do we connect the dots?" Dr. Ralph Aquila, who heads the Center for Reintegration in New York, posed his question to a ballroom full of winners of the Lilly Reintegration Awards, the awards that Dr. Aquila founded 10 years earlier with support from Eli Lilly and Company.
One hundred out of 115 past winners of the award had traveled to Indianapolis, October 5-7, from all corners of the country for the anniversary celebration and workshops. They were doctors, peer counselors, social workers, and others — many recovering consumers themselves — who have developed a wide variety of innovative programs for reintegration.
"The opportunity to get this kind of richness under one roof is rare," Dr. Aquila continued. "So it's now an opportunity: What would we like to see in a mental health delivery system, from your community to the national level?"
His query unleashed the Lilly award winners' prodigious creative energies, as well as a fair amount of their anger. After all, these are the people who have been nationally recognized for their programs that have put people on the road to recovery and reintegration. Yet most of them had often met great resistance to their efforts in fostering reintegration from a whole range of societal forces working against them. To answer Dr. Aquila's challenge, the group came up with a list of action steps for improving mental health in this country and knocking down barriers to reintegration. (See sidebar below for a summary of the group's recommendations.)
"We face a humanitarian crisis," declared Joel Corcoran, executive director of the International Center for Clubhouse Development (ICCD). "We have to recognize the crisis of mental illness and that our country hasn't responded to this life-and-death situation. First, we have to acknowledge that one in four families has a mental illness. Second, we have to believe in the potential for every single human being to live successfully."
Unfortunately, the humanitarian crisis is deeply embedded. Workshops at the anniversary event identified fundamental, and rather alarming, disconnects within the mental health community and in society in general, that are extremely harmful to reintegration efforts. One of the most serious problems: According to most of the Lilly Reintegration award winners, the majority of clinicians in the country don't even believe that recovery from severe mental illnesses such as schizophrenia and bipolar disorder is possible.
Healthcare providers, the consensus was, end up getting paid for symptom relief only, while they often ignore the larger goal of recovery.
"We're forced by insurance reimbursement practices to adhere to an Illness model, not a recovery model," declared one participant. "Insurance companies label somebody, take our premiums, but they're not providing the care toward recovery. That's the biggest fault."
Wanted: An Agreed-Upon Model for Recovery
But even among those who believe wholeheartedly in recovery, deep disconnects exist there too. The Lilly winners railed against the fact that there is no universally accepted model for what recovery means. The cries from the group rang out:
"We need a best-practice definition of 'recovery,' something we can all agree on."
"We need people educated with the same language of recovery."
Whatever the definition, the room's sentiments were clear when it broke into thunderous applause after one woman declared, "We believe people can recover from schizophrenia and live to their potential."
Individual workshops drilled down to examine some of the basic tenets of reintegration, and additional problems surfaced. One of the most distressing was that the award winners strongly believe that a majority of clinicians do not support one of the fundamental pillars of reintegration - consumer employment.
"Clinicians sometimes think employment will contribute to relapse, and you'll lose your benefits," exclaimed a participant.
What causes these gaps over fundamental issues of recovery and reintegration that divide so many clinicians and the Lilly winners? And, conversely, what can close the gaps?
Back to topEducation
The winners had a big part of the answer: education. They repeatedly spoke of grossly deficient training for mental health caregivers. From psychiatrists to undergraduates in social work, the professional curriculums being taught are a generation out of step with the times. Doctors are being trained in state hospitals with little chance for being exposed to community-based programs and the clubhouse model championed by groups such as ICCD.
Psychiatrists, for example, typically do their residencies in state hospitals. Never in their formal training do they get to observe the whole individual with mental illness, surrounded by a supportive community - the very model that the Lilly Reintegration Award winners have been fostering.
Newly minted social workers are continually surprised by what they see when they graduate and first enter a successful, community-based interdisciplinary program. Most of them have not had an educational frame of reference for community-based interdisciplinary programs.
"Even recent college graduates we hire are surprised at what we do. We need to challenge social work schools to bring these professions into the 21st century," said a participant. "Our new hires just out of school need to stop being surprised when they enter the workforce."
"Psychiatry now has the least-trained psychiatrists to work with the most mentally ill patients," said Dr. Thomas Liffick, a member of the Lilly Reintegration Awards judging committee and clinical professor of psychiatry at Indiana University School of Medicine. "Mental health providers in general need to be held in higher esteem, and that also relates to income."
But problems caused by out-of-date educational systems and low esteem for the profession go beyond the university level, and the group had much to say about the general education system. Kids learn about physical health in school, and adults never feel stigmatized if they call for a CPR unit if they're experiencing heart attack symptoms. But with little education offered about mental illnesses, stigma remains to infect the whole society. All individuals, even the professionals and consumers themselves, are sometimes guilty of perpetuating stigma.
Brian Whitehead, of the Cornerstone Reconnect Peer Centers in Tennessee, said, "There needs to be more education about stigma; that helps consumers regarding housing and jobs. It's also a problem that we never see positives in the media about mental illness, and that causes a lot of stigma."
"We should never underestimate barriers of stigma that occur even among professionals in our own field," said Jeff Kirschner, of the Greater Cincinnati Behavioral Health (GCB) Forensic Services.
Jean Newburg, of Weston United in New York, said, "Mental health and mental illness are on a big continuum, and we're all on it. If we're able to help the whole country look at mental health the same way we look at physical illness, that might be a strategy."
Back to topConnecting Dots
As the anniversary sessions drew to a close, attendees vowed to work harder at staying in touch with each other to "connect the dots." A database of winners and their programs will be instituted in 2007 so they can continue to exchange information and collectively address the pressing needs of the mental health community and society in general.
The lessons from the workshops and the anniversary were sobering. The winners' list of recommendations (below) makes up a sort of manifesto from the best and the brightest in the mental health community. These are the people who created award-winning programs that have consistently shown that people can and do recover, and that good jobs and good housing are essential to the reintegration process.
"No matter how ill people are, they want care, home and friends - not just symptom relief," concluded Dr. Aquila. "Care, home, job and friends — that's the outcome we're after. It's part of our job to help society as a whole to help us get there."
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WHAT THE REINTEGRATION AWARD WINNERS RECOMMEND:
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Lilly has made an investment in identifying the best programs, practices. To see a sampling of these winning programs and begin making connections, go to www.reintegration.com
