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

Chasing One’s Dreams with a Roadmap Out of Poverty

By Courtenay M. Harding, PhD

To work for a few hours a week or not to work and live on SSI/SSDI? …that is not the question! The question is: “How to dig out of poverty and chase one’s dreams?” Dreams, remember old dreams somehow lost way back when?  Participants, family members and providers attended an important meeting held by the DOH/MH, The Center for Rehabilitation and Recovery and many others on January 25th at the Bank of America building in midtown NYC.  A keynote speaker was Michael Morris, the Director of the Burton Blatt Institute of Syracuse University and The National Disability Institute in Washington, D.C.  He presented evidence that twice the number of people with disabilities, were impoverished than their non-disabled counterparts and that dependence on entitlements for food, housing, healthcare, and income kept people in a vicious circle of poverty.      

Many issues were discussed about financial literacy, empowerment, and economic self sufficiency.  The following critical components to lifting one’s self out of poverty and back into ones dreams were:

• Financial Education
• Credit Repair
• Asset Building
• Earned Income Tax Credits (EITC)
• Individual Development Accounts (IDA)
• Social Security Work Incentives
• Other Work Incentives (e.g. Medicaid Buy-In)

New partnerships are being formed among financial institutions such as credit unions, non-profits, government entities, and state and local agencies, micro-enterprise lenders to encourage people to rise above poverty to find their dreams of education, work, buying a home, becoming contributing members of their own communities.  There are also public policy and disability initiatives on the table.   In these times of economic stress for most people, “necessity has become the mother of invention” and attention is finally being paid and collaborations made to solve problems.

Participants (including Peggy Swarbrick, Oscar Jimenez, Linda Speaker, and Michael Nugent), rising above their own disabilities, described the hard work and success of reclaiming lives and dreams as brilliant examples of what is possible. 

Some of the available resources provided were:

• http://nyc.gov/html/ofe/html/home/home.shtml (NY Ofc. of Financial Empowerment) http://www.IDAresources.org  (Assets for Independence (AFI) Program)
• http://www.cfed.org/    (The Corporation for Economic Development)
• http://www.cfed.org/ida/  (Info on IDA and finding local IDA programs)
• http://www.scorecard.cfed.org   (Assets and Opportunity Scorecard)
• http://www.wid.org/programs/access-to-assets/equity  (WID Equity Newsletter)
• http://www.fdic.gov/consumers/consumer/moneysmart/overview (Free Money Smart Adult Financial Education Curriculum)
• http://crediteducation.org/index.php  (Centers for Financial Education)
• Burke-Miller, J., Swarbrick, M., Carter, T., Jonikas, J., Cook, J. (2010) Promoting Self-Determination and Financial Security through Innovative Asset Building Approaches.  Psychiatric Rehabilitation Journal. 34(2), 104-112.

PROGRESS NOTES

“To Be or Not to Be”: Suicide Myths and Strategies for Helping

By Susan Blayer

For those with a history of suicidal ideation, the question of existence is powerful and looming.  So many of our consumers, or perhaps even individuals in our personal lives, struggle with the decision to keep surviving in the midst of great emotional pain.

It seems that there are several myths about suicidal ideation and behaviors.  Perhaps this is because any talk of death makes people uncomfortable, frightened and confused.   Let’s take a look at some challenges to a few of the more common suicide myths:

* Suicide is selfish.
What is extrapolated through the fear and sadness of those who love someone who inflicts life-threatening damage on themselves is that the suicidal person is uncaring about how their actions affect those around them.  As Dr. Thomas Joiner argues in his book, Myths About Suicide1, lack of self-worth and self-esteem causes suicidal persons to seemingly discount the feelings of others.  This is not selfishness.  In fact, suicidal individuals tend to be quite concerned about who they may leave behind, yet their perception is often that people in their lives would be better off without them.

*Suicide is impulsive.
Dr. Joiner’s book also illustrates that suicide requires much consideration and planning.  Most cases of suicide attempts had been thought out for weeks, even years.

*No-harm contracts are effective in preventing suicidal acts.
Many clinicians and agencies insist that part of an effective crisis plan for a consumer with suicidal intent is to have them sign a “no-harm” contract.  However, researchers agree that there is no empirical evidence that the use of these contracts reduces risk of suicide, especially when required by a person outside of a genuine and trusting therapeutic relationship.2   Contracts constructed collaboratively around the person’s commitment to treatment might be more beneficial.

For anyone faced with an individual contemplating self-harm, the following is a list from my professional experience of clinical suggestions for prevention and intervention strategies:

* Take every suicidal gesture seriously.
Even if a person is unlikely to harm themselves, it is important to validate the pain behind the sentiment, as well as the courage it took to share those thoughts.  Listening carefully, asking questions without shying away from the subject or minimizing the person’s intent is essential to helping the person remain safe.

* Assessment and re-assessment are key.
Thoughtful and detailed assessment of immediate suicide risk is the first step to prevention and intervention for the distressed individual.  Asking specific questions about a suicide plan (when, where, how, etc.) and gathering a history of depression, anxiety, and recurrence of suicidal thoughts is essential, including escalation of any of these factors.

* Establish a safety and wellness plans and revisit often.
Safety plans are created with the person contemplating suicide, not for them.  Even in crisis, it is important to discuss what triggers suicidal desires, and help tease out motivations for staying alive.  A solid safety plan includes an emergency plan based on answers to such questions as, “Who can you call?,”  “Where can you go?’” and  “What can you do to avoid acting on your thoughts?”

*Identify a network of support to decrease isolation and encourage immediate disclosure of suicidal thoughts when they arise.
Those with the most serious intent may also be the ones most likely to withhold it.  Help the person involve friends, family, co-workers, peers and other professionals whom they trust and respect.  Educate others about the myths and realities of suicidal ideation.

* Explore spiritual beliefs around life and death, as well as participation in spiritual communities.
Some people may be reluctant to share their thoughts due to deeply held beliefs that suicide is immoral or a sin.

* Implement cognitive-behavioral therapies (CBT) and evidence-based practices.
 One large trial study found that CBT, which links thoughts and behaviors, significantly decreased the likelihood of suicidal acts over an 18 month follow-up.3  The American Foundation for Suicide Prevention provides a list of evidence-based programs (many of them targeting youth) on their website, http://www2.sprc.org/bpr/section-i-evidence-based-programs#programs.

I have found that using these techniques, while remaining present and calm with a person considering self-harm, can help them choose safety and accept continued help. 

Resources:
1. Joiner, T. (2010). Myths about Suicide. Cambridge: Harvard University Press.
2. Kroll, J. (2007). No-suicide contracts as a suicide prevention strategy. Psychiatric times .
3. GK Brown, Ten Have T, Henriques GR, et al. (2005). Cognitive therapy for the prevention of suicide attempts: a randomized control trial. JAMA , 563-70

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Center Trainers Certified as Benefits and Work Incentive Practitioners

Congratulations to Pat Feinberg (pictured on the right), Peer Educator at The Coalition’s Center for Recovery and Rehabilitation, and Margie Staker (on the left), MBI-WPD Project Coordinator, who both successfully completed their provisional 12-month certification as a Benefits and Work Incentive Practitioner from Cornell University’s Employment and Disability Institute. This certification acknowledges their successful mastery of core skills as the first step toward their permanent five-year certification.  The Center is proud of their accomplishment and all of their hard work.

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Education and Training

Recovering Together: Introduction to Group Work

This full-day training is designed for mental health practitioners who seek to harness the power of groups to support individuals in their recovery. The training may be of particular interest to providers of Personalized Recovery Oriented Services (PROS) since group work is the main service modality in PROS programs.

Participants will be introduced to theoretical concepts and fundamental skills essential for leading various types of groups, including knowledge-based, skills-based and therapy groups. The focus will be on developing group dynamics that engage and empower group members, motivate them to achieve personal goals and help the group as a whole recover. Through didactic and experiential learning, participants will acquire the skills they need to plan and lead groups that are meaningful and alive.

Facilitators: Aaron Vieira, LMSW; Susan Blayer, LMSW
Date:  February 22, 2011
Time:  9:30am – 4:30pm
Location: The Center for Rehabilitation and Recovery
Fee:  FREE!
Register now »         

To register for any Center training, please 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 “_”.    

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Other Community Events &  News

The JBFCS Martha K. Selig Educational Institute Workshop: Trauma Assessment & Treatment

The Jewish Board of Family and Children’s Services Martha K. Selig Educational Institute provides education training and support to agency clinicians and continuing professional development.  Their two-day intensive Trauma and Assessment Treatment Workshop will focus on trauma assessment, phase-based treatment approaches, and the impact of vicarious trauma on the clinician.   Participants will learn how trauma impacts children, adolescents and adults and an overview of various evidence-based treatment models will be discussed.  

Fee: $220
Date: February 7 & 8, 2011
Time: 9:30 am – 4:30 pm
Location: 135 W. 50th St., NYC
Register by emailing:  [email protected]

Real JOBS NY: Making the Business Case for Hiring People with Psychiatric Conditions

NYAPRS, in collaboration with the Workforce Development Institute (WDI) and the Syracuse University Burton Blatt Institute (BBI), is offering a free webinar which will focus on the information and tools necessary for making an economically sound case for hiring people with psychiatric disabilities in New York State.

Date: February  8, 2011
Time: 2:00 – 3:30pm
Location: Webinar
Register: http://www.surveymonkey.com/s/businesscaseforhiringPWPD-2-18-11

Lessening Agitation and Confrontation in the Emergency Room for Consumers

The Institute for Behavioral Healthcare (IBHI) is pleased to announce a free Webinar Series focusing on care of behavioral healthcare clients in Hospital Emergency Departments (EDs).  Drawn from the curriculum and experience of IBHI’s first collaborative, the series is made to share learning and engage others in new approaches and design to make care in EDs more effective. 

February’s webinar is entitled, “Lessening Agitation and Confrontation in the ED Practicing Fundamentals of Non-Coercion .“

Facilitator: Jon Berlin MD, Assistant Clinical Professor, Psychiatry, Medical College of WI
Date: February 9, 2011                    
Location: Webinar
Register: http://www.ibhi.net/ibhi-announces-two-webinar-series-january-march-2011/

Eli Lilly Solutions to Wellness Training Hosted by the Institute for Community Living

ICL will be hosting the upcoming Eli Lilly “Solutions to Wellness” full-day training. There will be various presentations on recovery, introducing Team Solutions and Solutions to Wellness and Delivery Skills.  The day will close with initial implementation planning and a question and answer period.

Date: February 17, 2011
Time: 9am – 4pm           
Location: ICL Corporate Offices, 40 Rector Street, 8th Floor Training Room, New York
RSVP by Phone: 212-385-3030  xt.3165

FREE Teleconference from SAMHSA’s Resource Center to Promote Acceptance, Dignity and Social Inclusion Associated with Mental Health

The SAMHSA ADS Center invites you to a free training teleconference titled “Housing, Homelessness, and Social Inclusion: Essential Elements of Healthy Communities.”   This teleconference will educate participants about current trends and practices in the field, recent precedent-setting court rulings to address violations of the Americans with Disabilities Act (ADA) and Olmstead, and the central role of social connectedness, social capital, and social inclusion as the foundation for developing programs that support people who have been homeless. Participants will also hear how one person moved from being homeless to being a homeowner and the lessons that can be learned from his recovery journey.

Facilitators: Livia Davis, M.S.W., SAMHSA Supportive Services Housing Technical Assistance Center; Bonnie Milstein, J.D.; David L. Bazelon Center for Mental Health Law;  Michael Kelly, CPS Housing for New Hope
Date/Time: February  23, 2011                    
Location: Teleconference
Register: http://promoteacceptance.samhsa.gov/teleconferences/default.aspx
(Please note that registration closes on February 20th at 5pm.)

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Publications and Reports

National Resource Center on Psychiatric Advance Directives

Psychiatric advance directives are relatively new legal instruments that may be used to document a competent person’s specific instructions or preferences regarding future mental health treatment.  Psychiatric advance directives can be used to plan for the possibility that someone may lose capacity to give or withhold informed consent to treatment during acute episodes of psychiatric illness.  The National Resource Center on Psychiatric Advance Directives provides an online step-by-step guide what you need to know about preparing your own psychiatric advance directive in each state.

For information about NY Psychiatric Advance Directives, go to:  http://www.nrc-pad.org/content/view/85/54/

Sponsored Employment Network Listserv

The Mental Health Association in New York State (MHANYS) is inviting providers and Employment Networks to join the MHANYS Sponsored Employment Network Listserv.  The listserv enables participants to learn from others and enhance the success of their Employment Networks.  The objective of Employment Networks is to give individuals with disabilities the opportunity to recognize their talents and capabilities by successfully connecting them with meaningful job and career opportunities and to build the skills and self-confidence needed for them to achieve on-the-job success. 

If you are interested in subscribing to the listserv contact Marsha Lazarus at [email protected]. 

Career Planning Curriculum for People with Psychiatric Disabilities

The Center for Psychiatric Rehabilitation at Boston University developed The Career Planning Curriculum for People with Psychiatric Disabilities  to guide rehabilitation practitioners in helping those with mental illnesses create a plan for attaining vocational goals.  The price of the curriculum, as well as its companion Reference Handbook, has now been greatly reduced. 

To learn more or purchase, go to: http://www.bu.edu/cpr/products/curricula/careerplanning.html

The 2009 National Survey on Drug Use and Health: Mental Health Findings

The Mental Health Findings report presents national estimates for the prevalence of past-year mental health disorders and past-year mental health service utilization of youth age 12 to 17, and adults age 18 or older.  This report was prepared by the Office of Applied Studies (OAS), Substance Abuse and Mental

Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS), and by RTI International (a trade name of Research Triangle Institute).

To view the report go to: http://oas.samhsa.gov/NSDUH/2k9NSDUH/MH/2K9MHResults.pdf.

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