Mark Salzer is the Director of the Temple University Collaborative on Community Inclusion of Individuals with Psychiatric Disorders. The Collaborative is funded by the National Institute on Disability and Rehabilitation Research (NIDRR) whose research focuses on what kinds of things support people with schizophrenia, bipolar disorder, and major depression to live in their communities like everyone else. Salzer recently gave this presentation on Brainshark.com.
As Salzer explains in the presentation, the numbers of people living in state mental hospitals and institutions has decreased dramatically—from just under 370,000 in 1969 to just over 41,000 in 2011. “However, while more people with mental illnesses are now living in the community… they are not of the community like everyone else.”
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Integrating Recovery and Community Concepts into Behavioral Health Practice
1. v
Mark Salzer, Ph.D.
Professor and Chair
Department of Rehabilitation Sciences, Temple University
Director, Temple University Collaborative on Community Inclusion
(www.tucollaborative.org)
Integrating Recovery
and Community Concepts into
Behavioral Health Practice
3. My Introduction to Recovery and
Community Inclusion: Ann the Person
Hi. My name is Mark Salzer. I am a clinical
psychologist who has worked with people
diagnosed with schizophrenia and other
psychoses, bipolar disorder, and major depression
in public mental health systems for approximately
25 years. During this time I have provided clinical
services, conducted research, and taught mental
health providers.
4. My Introduction to Recovery and
Community Inclusion: Ann the Person
At the beginning of my career, soon after
graduating with my bachelors degree in psychology
and sociology, I worked as a psychiatric technician
at a locked, acute psychiatric unit in Minnesota
where I grew up. Part of my job involved going
around the unit every hour to make sure that
people were still there. One day I was making my
rounds and knocked on the door of a young women
who had been admitted a few days earlier for a
suicide attempt. There was no answer. I knocked
again. No answer.
5. My Introduction to Recovery and
Community Inclusion: Ann the Person
I finally entered the room and found her crying
hysterically on her bed. I had never seen someone
cry so hard in my life. All I could think of while I
stood there was about her illness, that she was
depressed, and that she might want to kill herself. I
was thinking about calling a nurse or a doctor for
help. Thankfully, I did what likely turned out to
likely be the best thing – I sat down in the chair
next to her bed and listened.
6. My Introduction to Recovery and
Community Inclusion: Ann the Person
I expected to hear her talk about her depression,
how suicidal she was, and other similar, symptom-
oriented thing.
Instead, she started talking about she had just
recently gotten married and was worried about how
her husband was going to respond to her
hospitalization. “He is going to think he married a
lunatic who can’t keep out of the hospital,” she
said.
7. My Introduction to Recovery and
Community Inclusion: Ann the Person
She was worried about how her family was going to
react to her hospitalization. She was concerned
about losing her job. She was essentially worried
about the same types of things that I think about in
my life – relationships, work, school, and other
meaningful things in her life, how they were
effected by her mental health issues, and I would
now say, how they, and especially losing
participation in these areas, may effect her mental
health.
8. My Introduction to Recovery and
Community Inclusion: Ann the Person
This experience led me down the road to seeing
people with mental illnesses as people, not just
patients, and to understand the importance of a
recovery and community inclusion orientation to
how we provide all mental health services.
9. Perspectives on Recovery (Bellack, 2006)
• Medically-oriented perspective
– focus on symptom reduction; improved functioning;
decreased hospitalizations
• Consumer-oriented perspective
– Living a satisfying, fulfilling, and hopeful life with or
without symptoms of one’s illness
– Development of new meaning and purpose as one
grows beyond the catastrophic effects of mental
illness
10. Community Integration and Inclusion
• Community Integration: “The opportunity to live
in the community, and be valued for one’s
uniqueness and ability, like everyone else.”
(Salzer, 2006)
• Community Inclusion means actively working to
bring people who have historically been
excluded to "come in” to the community (to
participate) (Marsha Forest Centre --
http://www.inclusion.com/inclusion.html)
11. More people in the community….
(All Data From Annual report -- Admissions and
Resident Patients, State and County Mental
Hospitals, United States. Rockville, MD: Center
for Mental Health Services except * 2011 CMHS
Uniform Reporting System (URS) Output Tables
(page 9)
Year 1969 1984 1990 1998 2004 2011*
National 369,969 114,055 90,572 63,765 52,632 41,249
# of Individuals in State and County Hospitals at the End
of the Year
12. …but NOT OF the Community
• Housing
• Education
• Employment
• Financial independence
• Limited social roles
• Atrophied leisure/recreation
• Limited attention to spiritual
issues
• Limited encouragement to vote
• Limited self-determination
Salzer et al., in press
13. Would, Could, and Should Participate
• Would - People with serious mental illnesses want
– Work
– Good place to live
– Relationships
• Could – With the proper supports people can
– Lived independently in the community
– Work in competitive jobs
– Go to college and university
– Develop friendships and peer relationships
• Should – Participation has been found to have numerous positive
benefits
14. Behavioral Health Workforce Needs
• Well trained, committed workforce across the mental
health system
• Recovery and community inclusion concepts need to
permeate all aspects of what staff do on a day-to-day
basis
• Quality training makes a difference
• Building careers ladders may enhance long-term
connections to the behavioral health workforce
• Work-based learning opportunities are important for
knowledge and skill development
15. The Time is Now!
“We don’t have to lose another generation to a life
outside of the mainstream, If we act now – in our
practice, programs, and policies - to promote
community integration.”
- Richard Baron
15
17. References
• Bellack, A. S. (2006). "Scientific and Consumer Models of Recovery
in Schizophrenia: Concordance, Constrasts, and Implications."
Schizophrenia Bulletin 32(3): 432- 442.
• Salzer, M.S. (2006). Introduction. In M.S. Salzer (ed.), Psychiatric
Rehabilitation Skills in Practice: A CPRP Preparation and Skills
Workbook. Columbia, MD.: United States Psychiatric Rehabilitation
Association.
• Salzer, M.S., Baron, R.C., Menkir, S-M A., & Breen, L. (in press).
Community integration practice: Promoting life in the community like
everyone else. In P. Nemec & K. Furlong Norman (Eds.). Best
practices in Psychiatric Rehabilitation. Columbia, MD.: United States
Psychiatric Rehabilitation Association.
