From Victims to Heroes Many consumer leaders have brought their - PowerPoint PPT Presentation

Supporting Client Culture Webinar in Two Parts Webinar Part Two: From Victims to Heroes Many consumer leaders have brought their wisdom to this training. This training was compiled and developed by the California Association of Mental Health Peer Run Organizations (CAMHPRO) Karin Lettau, MS, Director of Training & Employment, klettau7@gmail.com Funded by the Mental Health Services Act through the Mental Health Services Oversight & Accountability Commission (MHSOAC) camhpro.org www.facebook.com/camhpro

Acknowledgements to Contributors • Vernon Montoya • Michele Curran • Sally Zinman • Sharon Kuehn • Gayle Bluebird • Lucinda Dei Rossi • Willy Collins • Jennifer Jones • Mary Jo O'brien • Eddy B. Alvarez • Tina Wooten • Angela Abbott • Maria Maceira • Karin Lettau Tulips are People IX • Richard Krzyzanowski Jerome Lawrence, • And so many, many more! Consumer 2

Webinar Format — How to Participate 1. Polling Questions In-webinar, click box to choose answer. We will show poll results. 2. Raise your virtual hand to be unmuted to ask a question or make comment. 3. Questions box--type in question or comment, send to all presenters 4. At the end of the webinar please complete the training evaluation. 5. Contact Technical Assistance from Advocacy Coordinator after the training. You may download all handouts from the control panel Poll: How many watching on your computer? 3

Poll: What region do you live in? 4

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CAMHPRO’s Mission • The California Association of Mental Health Peer- Run Organizations (CAMHPRO) non-profit consumer-run statewide organization • Members are consumer-run organizations and programs, and individuals. • Empower, support, and ensure the rights of consumers, eliminate stigma, and advance self- determination and choice. • Poll: How do you primarily identify? 6

Learning Objectives For better outcomes: • List social determinants of poor behavioral health outcomes that permeate client culture. • Describe how personal and systemic empowerment and recovery has redefined consumer identity and promoted transformation. • Specify how to apply client culture competency for more responsive strategies for better behavioral health services and outcomes. • Role of behavioral health providers • Role of consumers in behavioral health policy and program planning 7

Overview 8

Review Client Culture Part One Karin Lettau, MS, ITE 9

Surviving the Fire & Rising from Ashes to A Million Flowers • Phacelia grandiflora You may trod me in the very dirt But still, like dust, I’ll rise. – Maya Angelou 10

Client Culture: A Definition Mental health clients bring a set of values, beliefs and lifestyles that are molded as a result of their personal experiences of a mental disability, the mental health system and their own ethnic culture. When these personal experiences are shared, mental health clients can be understood better and empowered to effect positive system change. - DMH Info Notice 02-03

Impact on Quality of Life Diagnosis/ Labeling Medication Hospitalization Stigma Housing Unemployment Economic Impact Cultural, Racial and Ethnic Disparity Forced Treatment Michele Curran

Types of Mental Health Stigma • “Public Stigma” is the attitude and belief of the general public towards persons with mental health challenges or their family members. • “Institutional Stigma” is an organization’s policies or culture of negative attitudes and beliefs. • “Self - stigma” is when an individual buys into society’s misconceptions about mental health. (Disability Rights California) 13

Ethnically, Culturally, Racially, Sexually Diverse Groups Face Hig igher Stressors • Poverty, unemployment, crime, substance abuse, incarceration • Many cultures do not believe in western traditional medicine or psychotropic meds • Misunderstandings occur • Incorrect diagnoses • Mistrust of system • Increased non-disclosure • System lacks diverse staff Rivera: My Godfather’s Sons • High dropout rates from treatment 14

Summary of the Consumer Movement 1990’s 1980’s • Recovery culture 2000’s begins to replace • Begin consumer 1970’s • Funding amplified run programs chronicity culture 2010’s • Civil rights • Many states • State CA • More system- • Trauma informed • Big hospitals create peer Consumer funded self help & care and peer respite close advocacy certification, with peer support alternatives • Former patients organizations Medicaid programs developed. find each other & • More consumers reimbursement • Consumers • California are on decision meet to define • Consumer involved at most Association of making bodies core values and developed levels of MH • Government Mental Health Peer- goals trainings become system. begins to fund self Run Organizations mainstream help & peer • Consumers begin (CAMHPRO) • CA MHSA embeds support programs to be employed recovery values within system. into law Sally Zinman 15

Key CA Legislation State law: WIC 5813.5 Mental Health • (d) Planning for services shall be consistent with Services Act (MHSA) the philosophy, principles, and practices of the Recovery Vision for mental health consumers: o Voters passed in 2004, taxes 1% of (1) To promote concepts key to the recovery for residents’ income individuals who have mental illness: hope, personal empowerment, respect, social connections, self- over $1 mill. responsibility, and self-determination. o Funds multi- (2) To promote consumer-operated services as a cultural, way to support recovery. innovative, integrated services (3) To reflect the cultural, ethnic, and racial diversity of mental health consumers. (4) To plan for each consumer’s individual needs. 16

Social Determinants Affecting Behavioral Health Outcomes Karin Lettau, MS, ITE 17

Social Determinants of Health--WHO • Social determinants of health are the conditions in which people are born, grow, live, work and age. • These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. • Social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries. • World Health Organization (WHO) http://www.who.int/social_determinants/sdh_definition/en/ • See Handout SAMHSA CAPT p. 5-6 18

http://kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social- determinants-in-promoting-health-and-health-equity/ Clients Have Experienced Poor Living Conditions 19

A Public Health Framework for Reducing Health Inequities [Chart]. (2015). In BARHII. Figure 1: A Public Health Framework for Reducing Health Inequities – Bay Area Regional Health Inequities Initiative . http://barhii.org/framework/ 20

By Race/Ethnicity, CA Estimated MH Conditions vs Use of Services & Poverty % of state pop. % using services SMI est. % below 200% FPL SMI Est. % prevalence 4% 8% Multi-Racial 10.32% 5.91% 38% 30% Hispanic or Latino 7.46% 5.06% 39% 38% White 4.19% 9.17% 7% 18% Black/African Americans 9.20% 5.95% 2% 1% Native Americans 11.33% 7.07% 1% Pacific Islanders 4.29% 2.36% 14% 4% Asian 3.53% 21 1.74% Black/African

Estimated SMHC Prevalence % for CA Youth by Ethnicity and Poverty Level 9.12% 9.04% 8.94% 8.95% 8.91% 8.90% 8.88% 8.80% 8.02% 7.99% 8.00% 7.68% 7.56% 7.27% 7.16% 6.86% All Youth Asian Pacific Islanders Native Americans Black/African Americans White Hispanic or Latino Multi-Racial Estimated SMHC prevalence % Estimated SMHC prevalence % below 200% FPL 22

Rates of Suicidal Thoughts Are Higher Among Bisexual, Gay and Lesbian Adults Portrait of Promise: The California Statewide Plan to Promote Health and Mental Health Equity. A Report to the Legislature and the People of California by the Office of Health Equity. Sacramento, CA: California Department of Public Health, Office of Health Equity; June 2015. 23

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Social Determinant of Health: Trauma • Trauma — 90% of public mental health consumers have been exposed to trauma • DSM IV-TR: - Personal experience/knowledge of event involving actual threatened death or serious injury to self or another -Response to event involves intense fear, helplessness or horror -For children, disorganized or agitated behavior. -(Goodman, Rosenburg et al., 1997; Mueser et al., 1998 ) Poll: Choose the best list of social determinants health that permeate client culture. 25

Social Determinant of Health: Trauma • Nervous System Brain chemistry changes • Adverse Childhood Experiences (ACE) Study & Scoring • 10 Questions to 17,000 people • Higher score = higher risk of illness • 2/3 people ≥ 1 ACE • 1/5 reported score of ≥ 3 ACE • More information at: http://www.cdc.gov/ace/index.htm 26

ACEs and Suicide Attempts Compared with persons with no such experiences (prevalence of attempted suicide, 1.1%), the adjusted odds ratio of ever attempting suicide among persons with 7 or more experiences (35.2%) was 31.1 (95% confidence interval, 20.6- 47.1) 27