Employment Support at IOP Level

Colorado Recovery has expanded services outside our signature continuum of care. We are now admitting directly into our intensive outpatient program (IOP) clients who may be ready to begin their recovery at the IOP level of care, or for those in the process of stepping down from another program. One of the offerings now available at the IOP level is our employment group.

Meaningful employment is an important aspect of the treatment model originated by our late founder, Richard Warner. Clinical research shows that employment can improve outcomes of mental health treatment. “Several studies have shown that patients discharged from psychiatric hospital who have a job are much less likely to be readmitted to hospital than those who are unemployed, regardless of the patient’s level of pathology,” Dr. Warner wrote The Environment of Schizophrenia. 

“Finding suitable employment for clients as part of their treatment plan is the task of the employment group,” explains relocation counselor Dalma Farkas. “Clients learn and practice social skills which are essential for job searches and placements. Participants receive continued support, assistance, and encouragement—from each other as well—to successfully get back into the labor market.”

Employment support includes helping clients find a job, go back to school, or find volunteer work in the community. The group covers a lot of territory: how to write a stellar resume, how to prepare for a job interview, and how to keep a job.

Farkas usually gets things rolling with a thorough career assessment. “I ask them what they would like to do, what’s their dream job? I inquire about their job record and also find out what didn’t work for them to avoid bad experiences in the future.”

The trick is not to overwhelm clients. “We choose two to three job openings, but not more. We work on the resume to fit the job description. And, of course, we prepare clients for job interviews, going over a lot of possible questions like ‘Where do you see yourself in five years?’ or ‘What is this gap in your resume?’ We prepare at least 20-25 questions.” says Farkas. “They practice every day and when they get the job, we’re not done, either. We check in, ask how it is going, and inquire about the stress levels. Every client is different and has different needs so we need to be attentive and flexible.”

Sometimes, Farkas recommends a short job experience just to practice being in a work environment. Many clients don’t have an extensive employment history, they are typically young people who haven’t had much of a career, so they require quite a bit of help.

“Often, they don’t really know what to do, that’s where I come in,” says Farkas. “They may have tried the wrong job with long shifts that exacerbated their symptoms. We’re using those work experiences to find the right job for them. We avoid stressful, triggering places to avoid a relapse.”

The Warner model is all about empowerment through engagement because if people with mental illness lack a useful social role, they “face lives of profound purposelessness,” as Dr. Warner wrote. Like most of us, they are much healthier if they care passionately about their job. 

“I try to find jobs for our clients that are also their passion,” says Farkas. “Employment that still allows for recreational activities. Not a job that makes them go home exhausted and that makes their symptoms worse. Employment is supposed to improve their health after all.”

Another option is volunteer work. “Most of them have never volunteered before but Boulder offers many fantastic options here, one of my clients recently volunteered at a local museum,” recalls Farkas. “It turned out to be perfect for her—she is the happiest person now.”

For more information about direct admission to our intensive outpatient program or our other services, connect with a specialist who can answer your questions at (720) 218-4068.

Assessing Cognitive Symptoms in Schizophrenia

Cognitive dysfunction is a core feature of schizophrenia, wrote Christopher Bowie and Philip Harvey in their study “Cognitive deficits and functional outcome in schizophrenia.”

“Deficits are moderate to severe across several domains, including attention, working memory, verbal learning and memory, and executive functions. These deficits pre-date the onset of frank psychosis and are stable throughout the course of the illness in most patients.” 

It is now widely recognized that these deficits are among the best predictors of functional outcomes in schizophrenia. In a recent presentation for Psych Congress Network, Leslie Citrome, MD, MPH, clinical professor of psychiatry and behavioral sciences at New York Medical College, Valhalla, NY, discussed the significance of cognition in schizophrenia. 

“We’ve known for quite some time about the positive symptoms of schizophrenia, such as delusions and hallucinations, and the negative symptoms of schizophrenia, such as the lack of motivation, lack of interest, and difficulty in expressing emotion,” Dr. Citrome explained.

“We’ve also learned to acknowledge the existence of cognitive dysfunction. Problems, for example, with verbal fluency, with paying attention, with problem-solving. At the same time, we’ve also paid more attention to the affective symptoms of schizophrenia. These overlap somewhat with negative symptoms.”

Cognitive impairment is quite common in people with schizophrenia. This has been confirmed by a number of studies. For example, in a 2019 study published in the American Journal of Psychiatry, Zanelli, Mollon, et al. found that patients with schizophrenia and other psychoses had a cognitive decline in memory, verbal learning, and vocabulary over a 10-year period. 

“Cognitive impairment occurs in first-episode and chronic schizophrenia,” said Dr. Citrome. “We can observe that people with schizophrenia have a lower degree of cognitive abilities, relative to the general population, right from the beginning.” 

Cognitive dysfunction can serve as an early warning sign. “This can be apparent at the very first episode. In fact, can predate the first episode of psychosis,” said Citrome. “People who are in the prodrome, or even in their childhood or adolescence, can exhibit some degree of cognitive impairment.” 

It’s not always easy to detect cognitive impairment associated with schizophrenia. In his presentation, Citrome explained some of the diagnostic tools. “Cognition in clinical trials with schizophrenia can be formally assessed using neuropsychological testing. The standard today is to use a battery of tests called the MATRICS Consensus Cognitive Battery or MCCB.”

The MCCB consists of 10 tests that include testing the speed of processing, attention or vigilance, working memory, verbal learning, visual learning, reasoning and problem-solving, and social cognition.

Measuring cognition has an important purpose. “Cognitive deficits do predict functional outcomes,” explained Dr. Citrome. Testing cognition “helps us predict how well someone will function.” 

Current research appears to indicate that the existence of positive schizophrenia symptoms may not necessarily impair functioning, but impairment of cognition can lead to impairment in functioning, and negative symptoms may impair functioning.

That means that “hallucinations and delusions by themselves aren’t going to be the determinants whether someone can work or have social relationships,” said Citrome. “It’s going to be negative symptoms and cognitive impairment.” 

The Colorado Recovery treatment model emphasizes the experience of empowerment, the strengthening of social relationships, and overall support for people with schizophrenia to improve all aspects of their lives. “Recovery from mental illness is about more than just getting rid of the symptoms and staying out of hospital. It is about regaining a sense of identity, belonging, and meaning in life,” said the late Richard Warner, M.D. and founder of Colorado Recovery. 

Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses which are specific to each individual. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

The Correlation of Mental Health and Substance Use Disorders

According to the National Survey on Drug Use and Health, 9.5 million adults in the United States experienced both mental illness and a substance use disorder (SUD) in 2019. It’s a well-known correlation, complicating the treatment of the mental health disorder and the SUD.

“Many individuals who develop substance use disorders are also diagnosed with mental disorders, and vice versa,” explains an information page of the National Institute on Drug Abuse (NIDA). “Multiple national population surveys have found that about half of those who experience a mental illness during their lives will also experience a substance use disorder and vice versa.”

Mental health conditions and SUDs are frequently co-occurring because many people with addiction are primarily misusing addictive substances to self-medicate emotional pain caused by serious mental health disorders. 

According to NIDA, “Data show high rates of comorbid substance use disorders and anxiety disorders—which include generalized anxiety disorder, panic disorder, and post-traumatic stress disorder (PTSD). Substance use disorders also co-occur at high prevalence with mental disorders, such as depression and bipolar disorder, attention-deficit hyperactivity disorder (ADHD), psychotic illness, borderline personality disorder, and antisocial personality disorder. Patients with schizophrenia have higher rates of alcohol, tobacco, and drug use disorders than the general population.”  

Trauma in particular is an important predictor for substance misuse. According to PTSD United, 70 percent of adults in the US have experienced some type of traumatic event at least once in their lives, and 20 percent of those adults suffer from PTSD. Many traumatized people self-medicate with alcohol and drugs. “For many, if not most, people with addiction, trauma is perhaps the critical factor that causes the problem,” writes addiction expert Maia Szalavitz in her influential book Unbroken Brain.

The combination of bipolar disorder and substance misuse may be particularly challenging to diagnose and treat successfully. “Comorbid bipolar disorder and substance use disorder are frequently the rule rather than the exception,” wrote Suzanne Bujara on Psychiatry Advisor. “Bipolar disorder has among the highest rates of comorbidities, including anxiety disorders, obsessive compulsive disorder, impulse control disorders, eating disorders, cardiovascular and respiratory disorders, and sleep apnea. Not only are comorbid bipolar disorder and substance use disorder difficult to manage, but they also increase a patient’s likelihood for chronic infectious diseases, injury, and suicide.” 

Co-occuring mental health and substance use disorders should be addressed concurrently in a comprehensive treatment program addressing all needs of such patients. “Dual diagnosis” is a term used to describe the presence of addiction and other co-occurring mental health conditions. 

Colorado Recovery understands the importance of coordinated and integrative treatment care and provides substance use services to all clients who require them as part of a specialized dual diagnosis track. We recognize that many of our clients have employed non-prescribed substances to control the symptoms of their mental illness, and as a consequence may have exacerbated their health issues. 

The treatment process at Colorado Recovery starts with evidence-based assessment instruments that help a client understand the severity of their substance use disorder. Colorado Recovery uses the Substance Abuse Subtle Screening Inventory (SASSI-4) an empirically tested tool with a high-reliability rate. We also use the Addiction Severity Index (ASI-6) which was introduced in 1980 and it is probably the most widely used instrument to assess the severity of substance use disorders. Colorado Recovery also has the ability to administer screening tools to assist in identifying gambling and internet addiction disorders.

Colorado Recovery provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses which are specific to each individual. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

Movement Therapy at IOP Level

Colorado Recovery is now expanding services outside our signature continuum of care. We are admitting directly into our intensive outpatient program (IOP) clients who may be ready to begin their recovery at the IOP level of care, or for those in the process of stepping down from another program. One of the offerings now available at the IOP level is our movement therapy group.

Dance/movement therapy (DMT) is defined by the American Dance Therapy Association (ADTA) as “the psychotherapeutic use of movement to promote emotional, social, cognitive, and physical integration of the individual, for the purpose of improving health and well-being.”

“The basic tenet is that emotions live in the body,” says Colorado Recovery’s movement therapist Elise Alvarez. “It’s about creating awareness around clients, and then use movement to process those emotions. In case of anger management issues, we could ask ‘Is there a specific part of your body that you feel anger in?’ Anxiety might manifest as feeling a weight in the chest.” 

By expanding the awareness of such feelings, people are better able to recognize what’s happening in each present moment and then make more informed decisions about their feelings instead of simply reacting to them impulsively.

Even without verbal information, movement therapists are able to work with their clients. According to the ADTA movement is everybody’s first language. Without using words, just moving the body “can be functional, communicative, developmental, and expressive. Dance/movement therapists observe, assess, and intervene by looking at movement, through these lenses, as it emerges in the therapeutic relationship in the therapeutic session.” 

Alvarez goes into each session with a couple of specific ideas to be able to address the needs of individual clients in each particular group. In one recent session, she had clients toss a ball to each other in a pattern – a kind of group juggling. The purpose of the little game was to make people “wake up a little bit and become alert to what’s happening right now,” says Alvarez. 

Movement therapy has also physical benefits like improving reflexes and coordination. Group games strengthen cohesive teamwork, connecting people to each other as they work as a unit. 

“Sometimes we just throw a frisbee around—just having the movement aspect makes it feel more natural and fluid. People may open up a bit more because they’re moving and not just sitting in a circle, talking.” There is also walking meditation: “Everybody is paying attention to bodily sensations while walking, catching the mind should it start to wandering off,” says Alvarez. “At the end of a session we typically share our experience with the group. Our checkout question is often ‘How we are feeling right now?’”

For more information about direct admission to our intensive outpatient program or our other services, connect with a specialist who can answer your questions at (720) 218-4068.

 

Treehouse Planning Session at IOP Level


Colorado Recovery is now expanding services outside our signature continuum of care. We are admitting directly into our intensive outpatient program (IOP) clients who may be ready to begin their recovery at the IOP level of care, or for those in the process of stepping down from another program. Community integration and social engagement continue to be at the heart of the approach, setting the course for a life of engagement, purpose, and connection.

This non-institutional approach created by Colorado Recovery founder Richard Warner is key to outcomes associated with independence and self-respect. One of the offerings now available at the IOP level is our Treehouse Planning Session.

This group gives clients the opportunity to participate in their recovery plan and voice what they seek from the psychosocial program. We review any needs that they have toward connecting and contributing to the community or improving the space. It’s also a time for people to meaningfully get to know each other and develop friendships outside of a strictly therapeutic setting.

Dr. Warner considered schizophrenia and similar conditions bio-psycho-social disorders significantly affected by the environment surrounding the client on multiple levels. The Warner method harnesses the benefits of client empowerment to increase skills and work preparedness and assist them with social integration. 

The Treehouse planning group is an important element of that. On the one hand, it’s “a safe space to take a break and just hang out,” says Treehouse community organizer Elise Alvarez. “At the same time, it’s a great opportunity to build more comfortable relationships.” The Treehouse group highlights the value of social integration, “many people have found roommates and best friends here,” says Alvarez. “Treehouse gives a population that doesn’t have too much opportunity to socialize the chance to do just that.”

People are able to reach a deeper level of knowing one another while engaging in fun activities. “Hiking is always the most popular group,” reveals Alvarez. “Especially people who are not from Boulder appreciate the nature side Colorado Recovery has to offer.”

In Treehouse planning, people work out their budget, another aspect of empowerment. “It’s an important skill to come to a decision yourself and not just defer to the judgment of the coordinator. Often, I keep pushing it back to them, telling them ‘this is your space,’ so they get to make the call.”

It’s important to give clients some measure of control, to let them work out the budget and create the space the way they want it to be. “We typically start with me making announcements, and then open the floor to things they want to talk about,” explains Alvarez. “We’ve had discussions about terminology: should it be mental illness or biopsychosocial disease? Other times, we plan out dinners or days at the beach.”

For more information about direct admission to our intensive outpatient program or our other services, connect with a specialist who can answer your questions at (720) 218-4068.

 

People With Schizophrenia Have A Higher Risk of Suicide Study Confirms

The suicide risk for people with schizophrenia between the ages of 18 to 34 years is ten times higher than that for the general US population, according to a new study published in May.

The study from the Columbia University Department of Psychiatry looked at a large population of adults diagnosed with schizophrenia and found that the youngest group (18-34) had the highest suicide risk and those aged 65 and older the lowest. By comparison, in the general US population, the reverse is true: younger adults have a smaller risk and older age groups have a greater risk.

The Columbia study, published online in the journal JAMA Psychiatry also showed that people with schizophrenia, overall, have a 4.5-fold increased risk of dying from suicide, the 10th leading cause of death in the United States.

“When a person with schizophrenia is becoming suicidal, an attempt can happen with little warning,” said Mark Olfson, Elizabeth K. Dollard professor of psychiatry at Columbia and lead author of the study. “Often, suicidal behavior in schizophrenia is driven by psychotic processes. This aspect can make it difficult to anticipate and prevent.”

The study, which provides a significant amount of data on age and suicide risk, could help suicide prevention efforts for people with schizophrenia. “Knowing more about which age groups and what personal characteristics are linked to higher risk could increase attention and support for the most vulnerable patients,” Olfson said.

Colorado Recovery founder Richard Warner believed that recovery rates for schizophrenia and suicidal thoughts are also linked to the social and economic environment. 

In his classic Recovery from Schizophrenia, Dr. Warner pointed out a strong statistical correlation between lack of employment and suicidal ideation. “Work problems, economic stress, and unemployment appear to be important in precipitating suicide.” (2nd edition, 1994)

Unfortunately, discrimination and stigma prevent many people with a mental illness such as schizophrenia and bipolar disorder from finding purposeful employment. Too many of their fellow citizens believe people with such mental disorders are unable to work.

In a more recent book, The Environment of Schizophrenia, Warner wrote that “the mentally ill are among the most alienated people in our society, daily confronting the key elements of alienation—meaninglessness, powerlessness, normlessness, and estrangement from society and from work.” This induces an “existential neurosis” which in turn drives a significantly higher risk of suicide. “Many people with mental illness face lives of aimlessness and boredom,” wrote Warner.

Work can help overcome that sense of aimlessness and provide a better chance of recovery. “Productive activity is basic to a person’s sense of identity and worth. Given training and support, most people with schizophrenia can work,” Warner wrote. A productive life in recovery can also shield from suicidal ideation. 

Colorado Recovery approaches care for mental health based on a path of self-reliance through developed practiced skills. This non-institutionalized philosophy offers comprehensive levels of care supported by an expert medical and clinical team, engaging patients in increasing community participation.

Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses which are specific to each individual. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

Is It Schizophrenia? Is It Substance Use?

Around ten million adults in the United States currently experience both mental illness and a substance use disorder (SUD). It’s a well-established correlation, often complicating the treatment of both conditions. One such co-occurring disorder is schizophrenia

In a recent webinar for Harmony Foundation, Colorado Recovery’s medical director Alan Fine, M.D., talked about the symptoms of schizophrenia and substance use disorder and why it is frequently difficult to tell the two conditions apart.

 

 

First off, Dr. Fine presented a diagnostic flowchart to illustrate where SUD and schizophrenia can be found in the mental healthcare realm. If the symptoms are acute and were caused by taking drugs or drinking alcohol then we’re looking at substance misuse and a possible addiction scenario. If the diagnosis is psychosis without a physical cause, the condition is often diagnosed as schizophrenia or bipolar disorder. 

The diagnosis of schizophrenia itself is complicated and based on the work of three trailblazers in the field whose impact can still be felt today: Emil Kraepelin (1856–1926), Eugen Bleuler (1857–1939), and Kurt Schneider (1887–1967). 

Kraepelin is considered one of the founders of modern scientific psychiatry. His views dominated the field at the start of the 20th century. Bleuler renamed Kraepelin’s “dementia praecox” schizophrenia and established the classic four As of the condition: ambivalence, affect, alogia, and autism (preoccupation with self). Schneider in turn formulated the first-rank symptoms of schizophrenia: auditory hallucinations, feelings of external control, thoughts connected to others, and other delusions.  

In his book, The Environment of Schizophrenia, Colorado Recovery founder Richard Warner wrote that “schizophrenia is a psychosis. That is to say, it is a severe mental disorder in which the person’s emotions, thinking, judgment, and grasp of reality are so disturbed that his or her functioning is seriously impaired.”

What about substance use then?

By definition, schizophrenia is not caused by the effects of a substance or another medical condition. That, however, is not quite all. 

Mental health conditions and SUDs frequently co-occur because many people with addiction are primarily misusing addictive substances to self-medicate emotional pain caused by serious mental health disorders. 

“The proportion of schizophrenic patients of comorbidity of substance abuse varies in published studies from 10–70 percent, depending on how patients are diagnosed with schizophrenia, the types of populations studied, and the different ways of defining drug and alcohol disorders,” said Dr. Fine. “There’s a remarkable overlap in both directions.”

People with schizophrenia are at a higher risk of engaging in substance misuse because many of them will be tempted to self-medicate the severe symptoms of their mental illness as well as some of the side effects of their antipsychotic medications. At the same time, substance misuse may cause syndromes that are similar or even identical to schizophrenia.

In the short term (acute intoxication), schizophrenia-like symptoms may include delusions (stimulants and inhalants), loose associations (stimulants, alcohol, sedatives, and inhalants), and hallucinations (stimulants, alcohol, and inhalants). Both alcohol and sedative withdrawal symptoms include hallucinations and paranoia. 

In the long term (prolonged misuse), “amphetamine use is associated with long-term psychosis—thirty percent of all amphetamine-induced psychoses become chronic,” Dr. Fine explained. Chronic alcohol misuse may cause persistent dementias such as Korsakoff syndrome and delirium tremens. 

People with schizophrenia also engage in substance misuse to cope with the deterioration of their social environment, an area that Dr. Warner explored extensively. 

So, the answer to the question “Is It schizophrenia or is it substance misuse?” is often: both! That means, should both conditions be present, both need to be treated because they may reinforce each other. An important element in this regard is empowerment. 

Empowering people with schizophrenia reduces the need to self-medicate and often improves symptoms. Believing in their ability to take charge of their lives and manage the complex challenges of their illness is crucial for people with schizophrenia.

Over the course of his long professional career, the late Dr. Warner realized that social inclusion empowers people with mental illnesses and improves outcomes. “Work helps people recover from schizophrenia,” Warner concluded. “Productive activity is basic to a person’s sense of identity and worth.”

Colorado Recovery has been utilizing the Warner method to empower adults with mental illness for many years now. Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

 

What’s the Typical Age of Onset for Schizophrenia?

Schizophrenia is a mental health condition that affects about one percent of the US population. That means approximately 3.3 million people nationwide currently live with the condition. It typically starts in late adolescence or early adulthood.

“Schizophrenia is a psychosis,” explained Colorado Recovery founder Richard Warner, MD, in his book The Environment of Schizophrenia (2000). “That is to say, it is a severe mental disorder in which the person’s emotions, thinking, judgment, and grasp of reality are so disturbed that his or her functioning is seriously impaired.”

Schizophrenia can have very different symptoms in different people. They are frequently categorized as positive or negative. “Positive symptoms are abnormal experiences and perceptions like delusions, hallucinations, illogical and disorganized thinking, and inappropriate behavior,” wrote Dr. Warner in The Environment of Schizophrenia. “Negative symptoms are the absence of normal thoughts, emotions, and behavior; such as blunted emotions, loss of drive, poverty of thought, and social withdrawal.”

The onset of schizophrenia usually occurs between the ages of 16 and 30.

“Onset of schizophrenia before the age of 14 is rare, but when it does begin this early it is associated with a severe course of illness. Onset after the age of 40 is also rare, and is associated with a milder course,” wrote Dr. Warner.

Schizophrenia researchers have long been puzzled about why the illness normally begins in adolescence when important risk factors, such as genetic loading and neonatal brain damage, are present from birth or sooner. Some experts suspect that the natural and adaptive process of synaptic elimination in the brain during childhood—if excessive—could be a factor in the development of schizophrenia.  

“We now know that, for people with schizophrenia, this normally useful process of synaptic pruning has been carried too far, leaving fewer synapses in the frontal lobes and medial temporal cortex,” Warner wrote. “In consequence, there are deficits in the interaction between these two areas of the brain in schizophrenia which reduce the adequacy of working memory.”

There is wide variation in the course of schizophrenia as well. 

“In some cases the onset of illness is gradual, extending over the course of months or years; in others, it can begin suddenly, within hours or days. Some people have episodes of illness lasting weeks or months with full remission of symptoms between each episode; others have a fluctuating course in which symptoms are continuous; others again have very little variation in their symptoms of illness over the course of years. The final outcome from the illness in late life can be complete recovery, a mild level of disturbance, or continued severe illness.”

Left untreated, schizophrenia may result in severe problems affecting every area of life. Complications associated with schizophrenia include:

  • Suicide attempts and thoughts of suicide
  • Anxiety disorders and obsessive-compulsive disorder 
  • Depression
  • Misuse of alcohol or other substances
  • Financial problems and homelessness
  • Social isolation
  • Health and medical problems

Doctors cannot cure schizophrenia, but it is possible to live well if you have this mental illness. “People with schizophrenia can be treated effectively in a variety of settings,” wrote Dr. Warner. 

The treatment philosophy at Colorado Recovery includes a warmer and more human familial setting; comprehensive levels of care that result in a path of self-reliance; expert staff to better diagnose and treat clients; and community engagement for connection and a feeling of achievement. 

Since Dr. Warner’s passing in 2015, Colorado Recovery has continued to innovate its treatment approach based on these core principles. The Warner model has delivered exceptional outcomes through its signature continuum of care and helped create lives of purpose as clients practice new tools in the management of their mental health disorder.

Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses which are specific to each individual. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

 

The Impact of the Environment in Schizophrenia

Colorado Recovery founder Richard Warner considered schizophrenia a bio-psycho-social disorder significantly affected by the environment surrounding the person with the mental health condition on multiple levels.

In his book The Environment of Schizophrenia, Dr. Warner drew upon the “knowledge of the environmental factors that affect schizophrenia in order to suggest changes which could decrease the rate of occurrence of the illness, improve its course, and enhance the quality of life of sufferers and their relatives.”

Warner divided those environmental factors into three levels: individual, domestic, and community. 

The Individual Level

Among the individual factors, Dr. Warner listed the strong correlation between substance misuse and schizophrenia. “It seems to be true that people with schizophrenia use more drugs than others in the population,” he wrote in The Environment of Schizophrenia. Frequently, that behavior has a detrimental effect. Research has shown time and again that “people with serious mental illness who abuse substances have a worse course of illness.” However, Warner was adamant that substance misuse cannot cause schizophrenia although that is often how it seems to family members and other people. 

On the other hand, a mental health condition can be a driver of addiction. “Many in this population feel a need to find relief from chronic affective symptoms and medication side effects,” Warner wrote. Since the reasons for the substance misuse are complex, treatment approaches need to be individualized. 

Stress is another important factor on the individual level. Stress can trigger episodes of schizophrenia. “People with schizophrenia are more likely to report a stressful life event preceding an episode of illness than during a period of remission,” explained Warner. One of the hallmarks of schizophrenia is “a deficit in the regulation of brain activity so that the brain over-responds to environmental stimuli, reducing the person’s ability to regulate his or her response to new stresses.” 

The Domestic Level

Stress also plays a significant role on the domestic level. People with schizophrenia who live with relatives (by birth or marriage), who are “critical or over-involved” have a much higher relapse rate than those living with relatives who are less critical or intrusive. Outcomes can be improved if families are involved in a more supportive way. 

Studies have shown that “family psychoeducational interventions can lead to a change in the level of criticism and over-involvement among relatives of people with schizophrenia and so reduce the relapse rate.” With appropriate support, domestic stress can be mitigated for all parties involved. 

Dr. Warner included “alienating environments” at the domestic level. “Many people with mental illness face lives of aimlessness and boredom,” wrote Warner. While the traditional state hospital incarceration frequently led to an “instituional neurosis,” featuring restless pacing, unpredictable violence, and posturing, more recent treatment approaches may lead to an “existential neurosis,” which similarly stands in the way of recovery.

Open-door, domestic alternatives to hospitalization, on the other hand, offer a number of benefits, Warner wrote in The Environment of Schizophrenia. “They provide care which is much cheaper than hospital treatment, less coercive and less alienating, and they produce a different result.

The Community Level

On the community level, people with schizophrenia have to contend with numerous misconceptions and false assumptions about their disorder. “People with mental illness are subject to prejudice, discrimination, and stigma,” Warner wrote. 

Unfortunately, after being exposed to discrimination and stigma for a long time, people with schizophrenia start to accept negative labels about themselves and conform to the stereotype of a mentally ill person as being incapable and worthless. Frequently, they become socially withdrawn and dependent. 

The many harmful misconceptions about schizophrenia include the belief that

  • Nobody recovers from schizophrenia
  • Schizophrenia is untreatable
  • People with schizophrenia are usually violent and dangerous
  • Schizophrenia is contagious
  • Schizophrenia is the result of a certain weakness of willpower
  • People with schizophrenia cannot make rational decisions about their lives
  • People with schizophrenia are unable to work

Not only are most people with schizophrenia able to work, many of them should.  “Work helps people recover from schizophrenia,” Warner found. “Productive activity is basic to a person’s sense of identity and worth. Given training and support, most people with schizophrenia can work.”

At Colorado Recovery, the psychosocial clubhouse offers a rehabilitation model with a vocational focus that harnesses the benefits of client empowerment to increase members’ skills and work preparedness and assist them in obtaining employment.

Colorado Recovery—created by Dr. Warner—approaches care for mental health based on a path of self-reliance through developed practiced skills. This non-institutionalized philosophy offers comprehensive levels of care supported by an expert medical and clinical team, engaging patients in increasing community participation.

Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses which are specific to each individual. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

 

How Stigma Prevents Recovery From Mental Illness

Recovery from serious mental illness requires that people with such a condition retain a sense of empowerment—a belief in their ability to take charge of their lives and manage the complex challenges of their illness.

Empowerment is essential if people with a mental illness are to overcome the many prejudices that too many Americans still carry with them: the stereotype that makes them believe a person with a mental illness is incapable, unpredictable, even violent, and worthless. 

Colorado Recovery founder Richard Warner dedicated most of his life to fighting the stigmatization of people with mental illness. Shortly before his death in 2015, Dr. Warner explained the impact of this stigmatization on treatment outcomes.

 


 

Popular television programs often depict people with mental illness as dangerously violent. A 2007 study found that 37 percent of mentally ill characters in US primetime drama were violent criminals while only four percent of characters without mental illness were violent offenders. 

It’s a long-established bias, explained Warner. Surveys from Illinois in the 1950s showed that people across the board regarded “the mentally ill as relatively dangerous, dirty, unpredictable, and worthless” (Nunally 1961). This is the stereotype many of us grew up with. Among other things, it is based on a lack of understanding.  

A 1992 study found that an astonishing 58 percent of respondents considered “lack of discipline” a cause for mental illness, while 93 percent blamed “drug and alcohol abuse” (Borenstein 1992). This is similar to blaming “lack of willpower” for substance use disorders, suggesting people with mental illness (or addiction) are themselves largely responsible for their condition.

Common misconceptions about schizophrenia include the notion that it is caused by “bad parenting,” that nobody recovers from schizophrenia, that people with schizophrenia are usually violent, and that they are unable to make rational decisions. Sadly, while being perceived as violent, in reality, people with mental illness are themselves much more frequently the victims of violent crime compared to the general population. 

 

Stereotyping Leads to Discrimination

The result of evidence-free assumptions about mental illness is discrimination and stigmatization. As Dr. Warner explained, many landlords will automatically reject all applicants with mental illness. No surprise then that many people with mental illness feel the need to hide their diagnosis from others. Many who could work productively shy away from applying for jobs because they lack self-confidence and expect rejection. 

 

 

Internalizing stigma is a self-fulfilling prophecy. People who accept negative labels then conform to the stereotype of a mentally ill person as being incapable and worthless. They become socially withdrawn and dependent. 

In 1961, psychiatrist Frantz Fanon made a similar point about the dehumanizing effects of colonization upon colonized people who internalize the value judgments of their colonizers. The internalization of stigma leads to poor mental health outcomes unless the patient is able to reject the stigmatization and regain a sense of power and competence.

According to Warner, acceptance of mental illness (insight) with an internal locus of control can lead to empowerment and good outcomes while acceptance of mental illness with an external locus of control (internalized stigma, controlled by others) leads to poor outcomes.

“People who accept that they have an illness and have the greatest sense of internalized stigma have the worst self-esteem and the weakest sense of mastery over their lives,” Warner said. “Insight must be associated with decreased internalized stigma and with empowerment to lead to a good outcome.” This is the Warner method in a nutshell: treatment of serious mental illness must aim at decreasing internalized stigma and empowering patients to attain a certain degree of control over their lives. 

Many studies have since confirmed a strong, negative relationship of self-stigma with hope, self-esteem, and empowerment. Part of that empowerment is shared decision-making. More than ninety percent of “people with psychosis are competent to make choices about their medications,” said Warner. Unfortunately, many psychiatrists still show only minimal interest in involving patients in treatment decision-making. 

Another important element is utilizing mental health patients as peer support. The benefits of involving peer staff include reducing substance misuse and symptoms of depression and psychosis, while increasing hope, quality of life, and a sense of community inclusion. 

Colorado Recovery has been utilizing the Warner method to empower adults with mental illness for many years now. Our program approaches mental healthcare based on a path of self-reliance through developed practiced skills. Recognizing the importance of empowerment for recovery, our non-institutionalized philosophy offers comprehensive levels of care supported by an expert medical and clinical team, engaging patients in increasing community participation. 

Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.