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.

Skill building: An evidence-based service for today

We now recognize that getting rid of the positive symptoms—the hallucinations and delusions—of schizophrenia and other psychotic illnesses, is not enough to enable people to hold down jobs, and live independently. Rather, negative and cognitive symptoms, which are harder to treat, are often the key to recovery.

Good news

The good news is that skill building—a set of treatments that may be, at least in part, already familiar to you—is effective for these negative and cognitive symptoms, and has an evidence base which should satisfy clients, providers, and payers.

Evidence

This year, a review of more than 100 randomized controlled trials found that skill building helps people manage their illness, and their lives. Three treatments that target specific domains, as opposed to programs focusing on particular life skills, have the most data to support them. These treatments are:

• Social cognitive training to teach people how to identify the emotions on a person’s face, body language, and tone of voice, and help individuals interpret social events.

• Cognitive behavior therapy to teach people how to recognize distortions in their thought, and correct them. For more information, including a list of free online resources chosen by an expert, see Cognitive Therapy for Beginners and Thieves: An Interview with Judith Beck, PhD.

• Cognitive remediation to improve attention, memory, language, and higher-order skills. Alice Medalia, PhD, an international leader in cognitive remediation, explains how this treatment works in Using Cognitive Remediation to Move Toward Recovery, and explains how to set up a cognitive remediation program in Seven Common Questions about Cognitive Remediation.

The data indicate that integrated combinations of these three services make the best foundation for rehabilitation and recovery. Such blends include Integrated Psychological Therapy, as well as New York State’s Wellness Self-Management program (an adaptation of the national best practices Illness Management and Recovery program). Skill building develops attention and memory, as well as social and daily living skills. Skill building also improves illness management, reducing symptoms and relapses.

Consequently, the review concludes that skill building is a critical part of recovery.  We are thus fortunate that skill building is provided through PROS and clubhouse programs, and is also an integral part of the 1915-i services being proposed by the State through Medicaid redesign.

Additional information is available here.

Another reason to…

Tout recovery.  If people believe that individuals with a mental illness can recover, and function in society, they are more likely to say they are willing to have a person with mental illness as a neighbor, friend, in-law, and so on. This connection between belief in recovery, and the reduction in stigma, suggests that anti-stigma campaigns would benefit from showcasing recovery. Abstract

Provide reasonable accommodations. In a multi-state sample of individuals with psychiatric disabilities in supported employment, job accommodations were associated with working 7 hours longer per month. Job accommodations also appeared to decrease the risk of job termination by 13% over four years. Abstract

Integrate care for mental and physical health. A comparison of people with serious mental illness with a sample from the general population indicates that it is more difficult for the former to access medical care. This problem is most pronounced among individuals with depression, or who report difficulties in functioning. Specific burdens include longer wait times, and problems with transportation and the cost of services. The researchers conclude that the integration of mental and physical care envisioned in the Affordable Care Act might reduce the disparity in services for the more vulnerable population. Abstract

Integrating care for mental and physical health: A free RAND report

This month, the RAND Corporation published its free Examination of New York State’s Integrated Primary and Mental Health Care Services for Adults with Serious Mental Illness.

This report compares three New York State initiatives to promote integrated care for people with serious mental illness, and suggests how they can be improved. Recommendations include making it easier for mental health clinics to get licenses to provide primary care, and providing additional support for, and clarifying the roles of, peer support staff and primary care managers. 

Test your knowledge on: Diagnostic overshadowing 

1. Diagnostic overshadowing occurs when
   1. A person’s diagnosis of mental illness makes comorbid physical illness invisible to the physician
   2. Axis I diagnoses (vs Axis II diagnoses) receive a disproportionate amount of clinical attention
   3. Therapists focus treatment on DSM-5 disorders, rather than domestic violence, poverty, and other stressors  that affect functioning, even when these stressors are severe
   4. Borderline personality disorder hides the presence of other psychopathology
      
      
2. If two patients in the emergency room present with identical complications from diabetes, but one has a serious mental illness, and the other does not, who will be admitted?
1. Only the one with serious mental illness
2. Only the one without serious mental illness
3. The patient with better insurance coverage
4. Both will be admitted beginning in 2015, thanks to new federal legislation governing parity in treatment
   
   
3. Morbidity and Mortality in People with Serious Mental Illness, a classic 2006 review on the health of Americans with psychiatric diagnoses, found all of the following in people with serious mental illness EXCEPT:
1. Deaths, on average, twenty-five years earlier than the general population
2. Increased mortality due to multiple factors, including psychotropic medications that  masked symptoms of physical illness
3. Higher rates of modifiable risk factors, such as smoking and alcohol consumption
4. Greater use of preventive care in an effort to reduce hospitalization

Answers to: Diagnostic overshadowing 

1. a. Diagnostic overshadowing occurs when a person’s diagnosis of mental illness makes comorbid physical illness invisible to the clinician. 
   
   
2. b. If two patients in the emergency room present with identical complications from diabetes, the one without mental illness (as opposed to the one with mental illness) will be admitted, according to the results of one study of overshadowing. There is no new legislation mandating parity for 2015.
   
   
3. c. Morbidity and Mortality in People with Serious Mental Illness found all of            these trends in people except greater use of preventive care to reduce hospitalization among people with mental illness.

   Top

The opinions expressed in RECOVERe-works do not necessarily reflect the views of the Editor or the Coalition of Behavioral Health Agencies.

To subscribe or unsubscribe to RECOVERe-works, a free publication of the Center for Rehabilitation and Recovery at the Coalition, please email [email protected].

Top