Creating Community in Mental Health Practice Julius Lanoil Quotes - - PDF document

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Creating Community in Mental Health Practice

Julius Lanoil

Quotes

• 1)"The way out of madness is: To do useful things to contribute to the

environment." (Wilson Van Dusen )

• 2) "We are all longing to go home to some place we have never been — a

place, half-remembered, and half- envisioned, we can only catch glimpses of from time to time. Community. Somewhere, there are people to whom we can speak without having the words catch in our

• throats. Somewhere a circle of hands will open to receive us, eyes will

light up as we enter, voices will celebrate with us whenever we come into our own power. Community means strength that joins our strength to do the work that needs to be done. Arms to hold us when we falter. A circle of healing. A circle of friends. Someplace where we can be free." "The importance of belonging" by David Pitonyak

• 3) More than the hunger, the cold and the confusing things you see and

feel, is the pain of not being needed by a single soul." ( A homeless mentally ill person)

Julius Lanoil

• About me

6/27/2014 2 The Four Pillars of FH Community

FH an intentional community which has been replicated in hundreds of times in the US and around the world

1) Choice

• Choose their Coach and the Activities they wish to be

part of

• Opportunities in Ed group, Wellness group Research

group, Farm group at Highpoint, culinary group, intake group, RO group, clerical group, tutoring group

• Housing, employment, TE individual and group, social

Entreprises, supported employment, employment counseling, education of staff from other communities around the world program. College reentry, Evening weekend holiday recreation

2) The Staff as social practitioners and generalists

• Relate to members needs as a total person,

each staff responsible for

– 1)An activity area – 2) some amount of housing – 3) some number of employment placement in TE – 4) evening program recreation – 5) reaching out ( if isolating )

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3) Members are needed to help (Who needs the people with serious mental illness) - FH does

The FH structure is such that staff need members to help.

– Being needed celebrates a persons humanity – Confers dignity – Increases self-esteem – Increases the motivation to participate – Controls staffs arbitrary behavior and the members sense of helplessness

• Increases learning capacity (Vygotskies theory of

learning). (Note 8)

There are seven rules to helping someone feel needed:

• First there must be the perception that something worthwhile

needs to be done

• Second that worthwhile something that needs to be done must be

in a worthwhile context.

• Third the person being asked for the help must have the sense

that they are necessary to do the task.

• Forth the person being asked for help must feel that they have the

competence to do the task.

• Fifth, the leader asking for the help must offer the tools and or

support that insures that persons sense of competence.

• Sixth, the leader must feel that the completion of the task will

make a difference

• Seventh, after the work is completed, appreciation

4) XXXX

Fighting Infanitilization

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The Initial Goals

• Have the members feel they belong to the FH

community

• Opportunity to help themselves and others
• Feeling part of a dependable and stable structure’
• As discussed Feeling that that they are needed and

are relevant

• Belief that through membership their needs will be

met

• Develop a shared emotional connection
• In addition to belonging and feeling needed

Have the opportunity to do productive and necessary things at FH and in the general community

• Members have many opportunities to form relationship

(relationship deficit and mental illness,

• Have a significant relationship with a staff coach
• See the opportunities at FH that relate to their interests
• r passions
• Have their basic needs

Primary issue that limits successful treatment

• FH The Primary Issue in Accomplishing the

Goals is lack of Motivation – the primary negative symptom of serious mental illness. A Lack of Motivation

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• Positive symptoms are those most associated with

mental illness

• Negative symptoms are behaviors, thoughts or

feelings normally present that are absent in people with mental illness motivation and lack of motivation affect lack of affect cognition lack of some aspects of cognition

• Secondary negative symptoms are the result of the

illness such as low self esteem and self efficacy and stigma, poverty, poor health.

Lack of motivation

• Has a major affect on cognitive dysfunctions
• Is the negative symptom that inhibits functional

recovery

• Is the core negative symptom of schizophrenia and

that all of the other negative symptoms should be subsumed in this category When people regain their lost motivation their cognitive functioning also improves. Cognitive functioning improvements require an environment in which learning and improvements in self efficacy abound (S.M. Silverstein).

The process of Motivating

Treatment Elements at F.H

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Increasing self efficacy using the “side by side” process. Staff as transformational leaders

• Progressive task and interpersonal successes which

improves self esteem and confidence – increases in motivation to try new things.

• Reduces defeatist beliefs based on past failures
• Bandura – real vs. simulated activity

Bandura- self efficacy through mastery, vicarious experience and verbal persuasion Deci and Ryans- Self determination theory for intrinsic motivation and self actualization autonomy – choice, relatedness, relationships, competence- increasing self efficacy

Developing a significant relationship

• Staff functioning as motivational coaches
• Frank & Frank – “it’s the relationship”
• Can do for others, not self: people or

community they care about

• Theorem of successful risk taking

The Overall Process of Motivating members is governed by

• A strength based approach (Seligman

quote)"Strengthening Strengths will weaken weaknesses"

• "Using your signature strengths is concordant

with your intrinsic interests and values; hence in a supportive environmental context the clients strengths will become evident. This does not typically happen in a prescriptive way such as having the client complete a strengths inventory, but it occurs spontaneously in the relationship."

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• Providing positive experiences

– Negative and positive experiences are formative – Positive experiences are formative and curative – The primary positive experiences are

• Being needed: Being Needed Everybody has a need to be

needed, to feel relevant and necessary in the world. Regardless of age or life-limiting problems that need to be needed doesn't suddenly cease to exist. It has an energy force attached to it which will either find satisfaction through positive expression or if blocked, the energy attached to it will be repressed. (Chock full of nuts and thrift shop story)

• Experiencing success
• Having choice
• Having control and making decisions
• The opportunity to form relationships
• A normal life pattern
• Satisfying basic needs

Staff Role as Motivational Coach

• The Motivational Coach Role (our version of case management)
• Establishing a significant relationship
• What is it?

– Influential capacity (the ability to help others reassess beliefs and behaviorist- the likelihood that feedback will be heard and evaluated) – Mutuality (both parties allow each other into their lives and comfortable sharing “some” emotional and factual aspects of who they are – Authenticity – realness without professional façade – A focus on current strengths – Not Freudian transference – Respectful and trusting – Collaborative – Involves all domains of life – Becomes special to the members – Intense, yet with appreciation for member choice

• It comes about when there is:

– Basic acceptance – R.O. to start the conversation – Removal of obstacles to participation – Completing of the helping act – Giving realistic, honest, sensitive feedback (Cleaning glass story – Getting an initial “yes” (a “no” at this point can be destructive to the relationship) – Finding common interests – Active RO for problems (Isolation story) – A belief in the members future (hopefulness) – Sharing membership in the FH community – Providing leadership, charisma and enthusiasm

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• When Does It Develop?

– Staff see a challenge – Staff finds something to like and/or respect

• What does it lead to for the member?

– Progressive successes – Being needed – Staff being able to use themselves as models (Messenger story) – Avoidance of isolation – Less of a chance for re-hospitalization – Staff utilizing other members as models – Staff involvement in multiple domains of a members life

• Helps the member generalize their success at Fountain

House to other situations

• Guarantee that a member won’t fall through the cracks
• Supports risk taking (story of coat room) ( the importance
• f success on a risky project. The member succeeds and

then can generalize that success to other risky or fearful

• pportunities.
• Protects against plateauing

Staff Role as Transformational Designer

The role of the Transformational Designer (designing and leading in the work of the FH community)

– Shared leadership in decision making in the work – Organizing the daily work – Deconstructing the work for success – Discussing its relevance – The social climate of joyful hustle – Celebrating success – Promoting wellness

6/27/2014 9 Why Does This Work at FH

• To service the needs of the membership its

real and necessary

• To provide an opportunity for staff to

develop a significant relationship

• To facilitate increases in self-efficacy that

come from the experience of mastery and progressive successes

• To create a need for member assistance

The Process of Increasing Self Efficacy in “side by side” work

Staff:

• Break down tasks into subtask
• Correct fearful or faulty thoughts about the task
• Demonstrate the task
• Give reasons
• Clarify goals
• Keep duration of the task consistent with members time limitations
• Use member as model when necessary to teach others
• Generalize the task to other circumstances
• Give honest and supportive feedback
• Let member do task alone to lock in mastery experience
• Have member teach to others
• Discuss next, more complex assignment

TE is an extension of “side by side” in the general community (See my paper on TE)

• TE is a therapeutic tool
• TE incorporates the need to be needed
• TE increases self efficacy in the real world of

work

• TE is not just a form of supported

employment

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How Activities are Created in the Fountain House Working Community.

A) Establishing Relevance and Appropriateness

• Any new unit or new programs within an existing unit must improve the quality of life for the

membership and or facilitate the growth, efficiency, stability or security of the community. B) Community integration

• After the relevance to the community has been established all of these start ups require the

4Ws, when will it be done, where will it be done, who will do it and what equipment will they require. C) Regularity of performance

• Is the first rule for the community integration of programs. This means that regularity of time

and place must be maintained once schedules are established, so that community members can plan their participation. D) Assimilation plan

• A plan needs to be devised that will advertise and market the benefits of the new program

to the membership of the community. This assimilation plan is the second rule of community integration. E) Program Utilization

• Ultimately it’s the utilization of the new program by the membership that will define

successful assimilation and utilization is defined by the amount of perceived relevance the program has to the membership of the community

Thank you!