The Center for Rehabilitation and Recovery provides assistance to the New York City mental health provider community through expert trainings, focused technical assistance, evaluation, information dissemination and special projects.

THE DIRECTOR’S NEW YORK MINUTE

What in The World Is a Health Home?

By Courtenay M. Harding, PhD

Just as we were getting used to PROS (personalized recovery oriented services) here in NYC, along comes word from the Medicaid Redesign Team in Albany that the behavioral health community will be reorganized into health homes starting  November 1st!  Well, in my opinion, health homes are what the system should have been from the beginning of time because it essentially consists of real integrated care plan treating the whole person at long last.  Since René Descartes (1) split the mind and body in the 17th century, we have been splitting care-- the body in one place and the mind in another. Our current system began in the mid- 1940s pushed through by the Robert Felix and the National Mental Health Act (2).   Whole institutions, professional fields of practice, theoretical models, and funding streams were siloed into physical care, mental problems, and substance abuse (3).

When I was a nurse at a state hospital, I found that medical co-morbidities were systematically unrecognized and left untreated.  When I was an ICU nurse at a prestigious Boston hospital, in which my small patients suffered from serious brain tumors sent to us from around the world, the psychological consequences to both the parents and the staff were also ignored.   Up until recently, even the practice of general medicine has been splintered. If a housewife complained of being tired and out of sorts, the local GP might order a series of lab results with the possibility of depression ignored.  If a psychiatric patient entered the ER, just a glimpse of the person’s current medication list made the staff think that it was all in the person’s head with the possibility of a cardiac emergency ignored.

Improved understanding of the body, its’ brain, the mind, and the environment has produced some exciting research evidence that everything interacts with everything else (4-6) and makes second by second changes in the entire system (7).  Therefore, it behooves us to treat the whole person as a team of people working together (8). 

New York has gotten itself into quite a pickle.  Of the 5.4 million New Yorkers on Medicaid, there are 976,000 Medicaid enrollees with serious complex co-occurring disorders (20%) and they cost us 26 billion dollars out of the total 46 billion spent on care.  They come to care when they are desperate and their problems have escalated out of control.  They fill the ERs and costly hospital beds.  New York is the worst in the nation with such expenditures and the patients are struggling.

Taking advantage of the national Affordable Care Act offer to pay 90% of care coordination, the State has decided to weave the system together by offering networks of care starting November 1st,  which will include a partnership of hospital, other direct care providers, TCM, COBRA, MATS, CIDP programs and other community based organizations (such as housing)(9).  Those disconnected persons will be assigned a Health Home which will be responsible for engagement, treatment, linkage, and follow-up.  The goal is to provide coordinated, integrated, and comprehensive medical and behavioral health care. Efforts will be made to keep current connections already made intact.   This vision is about 400 years overdue.

References

1. Descartes, R.  (1641) Meditationes de Prima Philosophia, Leiden.
2. National Mental Health Act. (1946)
3. Dworkin, R. W. (2010) The Rise of the Caring Professions.  Hoover Institution, Stanford University, Palo Alto.
4. Ciompi, L. (1988) The Psyche and Schizophrenia:  The Bond between Affect and Logic.  Harvard University Press.  Cambridge, MA.
5. Damásio, A. (1994) Descartes’ Error: Emotion, Reason, and the Human Brain. Putnam.
6. Ramachandran, V.S. & Blakeslee, S. (1998) Phantoms in the Brain: Probing the Mysteries of the Human Mind. William Morris of Harper Collins Pubs, New York City
7. Pert, C. (1997)  Molecules of Emotion:  Why you feel the way you do.  Touchstone, New York.
8. Gawande, A. (May 26, 2011) Cowboys and Pit Crews. The New Yorker,
9. http://nyhealth.gov_care/medicaid    downloaded 08/18/2011

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PROGRESS NOTES

Change the Size of the Glass: The “Skeleton of Hope”

By Susan Blayer

When I told our Center Director, Courtenay Harding, that I was thinking about writing about optimism for this month’s “Progress Notes”, she said, “Well, you know what they say about that?  Don’t worry if the glass is half empty or full, just change the size of the glass!” 

Although she meant it as a joke, it made me wonder about optimism.  Is it genetic in origin? Can it be learned?  If so, is it a worthy endeavor to shift pessimistic tendencies (or those of others) so that they are more Pollyanna-like? What is the most beneficial way to see that glass? Can we change its’ size, so to speak?

We know that this is how our culture generalizes the two sides of the coin: optimists see the glass as half-full; pessimists see the glass as half-empty.  But surely some might see the glass as twice as large as it needs to be. (Hence, change the size of the glass.) Others might say that it is not empty at all, instead, that it is filled with space (nitrogen, oxygen) and liquid. (Therefore, the size of the glass is neutral.)  The philosophical aspects of the debate could leave us entangled in myriad questions rather than finding any solid information about the subject.  So, in the words of DJ Lance, “Let’s break it down!”

Are optimistic/pessimistic dispositions genetic?

In the early nineties, a research team, (including Dr. Martin Seligman, professor of psychology at the University of Pennsylvania and “Positive Psychology” pioneer), sought to answer this question by studying twins. They found that there was a moderate genetic link to optimism. (1)  More recently, scientists at New York University discovered that those with a more upbeat outlook had a “cluster of neurons” which created “a brain built for optimism.” (2)  In other studies, British psychologists at Essex and Bath Universities identified a specific genetic variation in optimistic people that suggests that they are hardwired to focus on the positive and minimize the negative aspects of life situations.  Those individuals who inherit two long versions of serotonin-controlling genes will tend to be optimists, while people with two short versions tend to be more neurotic and anxious, with a higher risk of depression. (3)

Can optimism be learned?    
    

In spite of genetic predispositions, Dr. Seligman contends that optimism, which he has called “the skeleton of hope,” can be learned.  His book, Learned Optimism: How to Change Your Mind and Your Life(2006), draws on more than two and a half decades of clinical research to demonstrate how pessimistic people can practice looking at the glass as half-full. Seligman teaches the reader how to create a new internal dialogue through cognitive skills that reduce pessimistic thought patterns while increasing optimistic attitudes. Piggy-backing on Seligman’s foundational work in Positive Psychology, researcher Dr. Barbara Fredrickson agrees that optimistic traits can be taught.  She provides lab-tested tools necessary to increase a positive outlook in her book, Positivity: Top Notch Research Reveals the 3-to-1 Ration That Will Change Your Life(2009).  In the book, she asserts that we should strive to experience 3 positive emotions for every 1 negative emotion, focusing on 10 prominent forms of positivity: joy, gratitude, serenity, interest, hope, pride, amusement, inspiration, awe, and love.

It is healthier to be an optimist or a pessimist?

There seems to be substantial evidence that optimism may be beneficial to our wellness. Researchers Aspinwall and Taylor found that optimists have an easier time adjusting to major life transitions than pessimists do. (4)  In general, a theme of several research findings suggest that optimists tend to use more problem-solving strategies, as well as adaptive coping mechanisms such as acceptance, humor and positive reframing.  Pessimists, by contrast, tend to disengage, particularly through denial and rumination, rather than address a problem. (5) Seligman reports that pessimists perceive difficult life events as being permanent, pervasive and personal in nature, while minimizing those same aspects of good events. There is, according to Seligman, one distinct advantage that pessimists have over optimists:  Pessimists assess life situations in a more accurate and realistic way, while optimists tend to exaggerate the amount of control they have over events.(6) An author of a recent Time online article explores these pros and cons, “ Overly positive assumptions can lead us to disastrous miscalculations—make us less likely to get health checkups, apply sunscreen or open a savings account, and more likely to bet the farm on a bad investment.  But [“the optimism bias”--belief that the future will be much better than the past and present] ..protects and inspires us: it keeps us moving forward rather than to the nearest high-rise ledge.” (7)

For providers and consumers alike, it is important to note that individuals with severe depression or thought disorder will not benefit from the types of cognitive training illustrated by Seligman and Fredrickson.  However, it may be a worthy endeavor to look into clinical applications for increasing optimism in many other consumers. Given the data, it seems that learning to be more optimistic is not a one-size-fits-all, all-or-nothing prospect.  Like all psychological growth, it is a customized process. To change the size of the optimism/pessimism glass means working toward adjustments in perception over time.   We can help those individuals, (and perhaps ourselves!), who automatically jump to the negatives and stay stuck there, to alter the size of their particular glass, slowly but surely, so that there is a healthy balance of realism, accountability and positivity.

If Seligman is correct when he proclaims that optimism is the “skeleton of hope”, then, indeed, it follows that it is also the backbone of recovery.   American author and philosopher, Noam Chomsky, sums up this notion precisely: "Optimism is a strategy for making a better future. Because unless you believe that the future can be better, you are unlikely to step up and take responsibility for making it so."

References

1. Shulman, P. Keith, D. and Seligman, M. (1993)  Is optimism heritable? A study of twins. Behavior Research and Therapy,  31(6), 569-574.
2. Hotz, R. (2007) Except in One Career, Our Brains Seem Built for Optimism. Retrieved from the Wall Street Journal online: http://online.wsj.com/article/SB119454102049486710.html
3. Sample, I. (2009) Psychologists find gene that helps you look on the bright side of life.  Retrieved from Guardian.Co.Uk. online: http://www.guardian.co.uk/science/2009/feb/25/optimism-brightside-gene-mental-health
4. Aspinwall, LG, and Tayolr, SE (1992)  Modeling cognitive adaptation: A longitudinal investigation of the impact of individual differences and coping on college adjustment and performance. Journal of Personality and Social Psychology, 63, 989-1003
5. Scheier, MF, Carver, CS and Bridges, MW (1994)  Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the life orientation test. Journal of Personality and Social Psychology, 67 (6) 1063-1078.
6. Seligman, M (2006) Learned Optimism: How to Change Your Mind and Your Life Vintage Press.
7. Sharot, t. (2011) The Optimism Bias.  Retrieved from Time magazine online: http://www.time.com/time/health/article/0,8599,2074067,00.html

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Center News

Center Staff Provides Guidance on Leading Curriculum-based Groups

To assist staff in PROS programs, Center Associate Director, Aaron Vieira, recently wrote an article that explains how to effectively lead curriculum-based groups. The key is to skillfully balance the demands of task management (i.e., progressing through a set curriculum) with the demands of process management (i.e., developing healthy communication and interaction patterns, etc.). The article offers many practical suggestions on how to strike the right balance. By applying these suggestions, group leaders will be better equipped to create growth-enhancing, group environments where recovery can flourish.

To read the full article, visit the NYAPRS PROS Curriculum Clearinghouse webpage or click this link: http://pros.nyaprs.org/2011/07/providing-effective-leadership-for-curriculum-based-groups/.

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Education and Training

Center Education and Training

To review trainings held in June and preview scheduled trainings for this Fall, go to: www.coalitionny.org/the_center/training/    Note: If you are typing the URL in your browser, the space between “the” and “center” is in reality an underscore symbol “_”.

 Remember, keep checking our website for open registration for upcoming trainings: www.coalitionny.org/the_center/training/ 

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Other Community Events &  News

National Recovery Month

September is SAMHSA’s National Recovery Month, a national observance to promote recovery awareness. Now in its 22nd year, National Recovery Month highlights individuals who have reclaimed their lives and are living happy and healthy lives in long-term recovery and also honors the treatment and recovery service providers who make recovery possible. The 2011 Recovery Month observance aims to educate the public on the positive changes that national health care reform will have on access to needed recovery services for substance use and mental disorders.

Your organization can plan a recovery event, (a walk, an open house, a barbecue, a conference, a rally, an art show etc.) Post your event on the SAMHSA website for more exposure and participation for your event. You also can select to be eligible to win a Recovery Month Community Event Award:  http://www.recoverymonth.gov/Community-Events.aspx

Raise awareness and show your community's commitment to recovery by issuing a proclamation. Proclamations show that your community, city, county, or state recognizes National Recovery Month and the important role that people in recovery play in your community.  To learn more about proclamations: http://www.recoverymonth.gov/Recovery-Month-Kit/Media-Outreach/Official-Proclamations.aspx

USPRA Online Course: Professional Development for the Front-line Supervisor

This on-line course is a highly interactive training experience designed to provide a series of foundational skill sets, tools and techniques vital to the success of the front-line supervisor in the behavioral healthcare organization. This is an instructor led, self- paced course, running for six weeks and offering 24 hours of continuing education credit. The fee for this course is $325, USPRA Member, and $385, Non-Member.  Maximum class size is limited to 36 participants.

Facilitator: David R. Selden, ACSW, LICSW
Dates:           September 12 - October 30, 2011          
Location:   Online, at participant’s convenience
To learn more, including registration information: https://netforum.avectra.com/eweb/DynamicPage.aspx?Site=USPRA&WebCode=online_learningsupercharg

Free Trainings for NYC Non-Profit Boards Members

The New York State Board Training Consortium (SBTC) is offering trainings for board members of not-for-profit organizations throughout the state. The September schedule includes a “Making and Documenting Board Decisions” webinar, as well as workshops which cover topics such as the board’s role in working with staff leadership, fund development for non-profit boards and non-profit board member responsibilities for governance of Medicaid-supported programs in NYC. The SBTC trainings are developed and presented by New York Council of Nonprofits, Inc. and sponsored by 5 state agencies: OASAS, OMH, OPWDD, OCFS and DOH’s AIDS Institute and Center for Community Health.

To see the full schedule and register go to: http://www.eventbrite.com/org/101900344?s=1017028

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Publications and Reports

Mental Illnesses Mistaken for Medical Conditions

The August edition of the Wall Street Journal Health Journal highlights the prevalence of psychological symptoms which can be attributed to medical conditions in the article, “Confusing Medical Ailments With Mental Illness.”   Harvard psychiatrist Barbara Schildkrout reports that over 100 medical illnesses can be masked as mental health disorders and states, “Untangling cause and effect can challenge even seasoned clinicians, and the potential for missed diagnoses is growing these days.” 

To read the full online version, including a list of when to question if a seemingly behavioral problem may be medical, go to: http://online.wsj.com/article/SB10001424053111904480904576496271983911668.html

Reducing Stigma Associated with Mental Health in Black Communities

According to a recent article in Behavioral Healthcare, statistics indicate only 1 in 3 Black people who need mental health care receive it due to significant barriers in Black communities including racism, institutional mistrust and lack of insurance.  A new website, BlackMentalHealthNet.com, has been designed to empower the Black community by promoting mental health and by creating a private space for individuals to find information and resources.   Dr. Sarah Y.Vinson, a Harvard-trained, Black psychiatrist and founder and chief editor of BlackMentalHealthNet.com, states, "Stigma often stifles the conversation regarding mental illness in the Black community. Families too often base decisions on little information or misinformation. We hope to change that by providing facts and facilitating dialogue around mental illness in an environment of relative anonymity and acceptance." 

New SAMHSA Evidence Based Practice Toolkit

SAMHSA is now offering a free toolkit for developing mental health services that are owned and operated by people who have personal experience living with a psychiatric disorder. The kit, which is made up of 10 booklets and provides guidance grounded in evidence-based practices, can be downloaded here: http://store.samhsa.gov/product/SMA11-4633CD-DVD.

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