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.

 

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.

 

The Role of Work and Community in the Treatment of Schizophrenia

Read more

Empowering People with Mental Illness at Colorado Recovery

Read more

Upcoming Training with Expert in Communicating with Someone Experiencing a Mental Health Challenge

Do you ever struggle to connect and communicate with a loved one who is experiencing a mental health challenge? Dr. Xavier Amador is an internationally renowned clinical psychologist, expert, and author specializing in communication tools to help support people with mental health disorders like schizophrenia or bipolar disorder. Dr. Amador developed his evidence-based techniques to help him develop a better relationship with his brother, who was diagnosed with schizophrenia. He founded the  LEAP® (Listen-Empathize-Agree-Partner) method. Many family members and caregivers have found his techniques very helpful. 

 

Colorado Recovery encourages families and caregivers to read his book, I Am Not Sick and I Don’t Need Help, or attend an upcoming training listed below. 

Dr. Xavier Amador will be presenting an online training session—live with Q&A! 

Wednesday, January 13, 2021, @12:00pm-3:00 pm Eastern Time (the US and Canada)

This session is for Family Caregivers and Professionals who want to help someone with serious mental Illness and anosognosia—the neurological symptom that leaves a person unable to understand s/he is ill, resulting in conflict, isolation, and treatment refusal.

Participants will be introduced to LEAP® (Listen-Empathize-Agree-Partner), an evidence-based approach that teaches you how to create relationships that lead to treatment and recovery. Learning objectives include:

  • Identify Anosognosia vs. “Denial”
  • Lower Anger, Resistance & Defensiveness
  • Re-establish Trust & Broken Relationships

Cost

$130 Early Bird (ends Dec 11), $150 Regular

LEAP Foundation is a small nonprofit and 100% of proceeds from this session are used to fulfill the organization’s mission.

More info: https://lfrp.org/online-trainings

“Shssss……(she said so quietly)……I am on medication!”

She was 17 years old and came by the booth that I was hosting on mental health challenges.   Even before she whispered this to me, she had looked around to make sure no one else was listening.  I leaned in and she told me that she has been living with depression and finally she talked with her mom and found a therapist and therefore the medication.  Her depression had clinging to her spirit weighing her down for a long time.  But now she is engaged with others, a member of a church youth group, and has even had the courage to tell one of her closest friends of her struggles with depression.

I felt privileged that she would talk with me, a stranger, although I was at a church conference and I was at a display on mental health.  She seemed relieved to be able to speak, to name her situation, and to find a listening heart.

There are so many people, including young people, who are living in the shadow of mental health challenges.  They are in our families.  They are in our faith communities.  How can we offer the hospitality of spirit so that the sharing of such stories as the teenagers can be balm for healing and offer hope?

One of the easiest ways is by using caring and compassionate words in a clergy person’s sermons, homilies, or prayers.  While many congregations are not known for such welcoming of naming mental health challenges, they can be.  Using the words, “we pray for those who are living with bipolar disorder, schizophrenia, or major depression,” or “we pray for those who are battling addictions or mental illness,” or “we pray for those who are affected by mental illness, including their families and friends,” can be an open door for people who are living in the isolation of silence and to come out and speak or at least realize they are not alone.

When have you experienced such a welcome?  When has hospitality opened a door for you or someone you love to find a place where their spirit can be at home?  I don’t really know if the 17 year old girl felt better talking with me.  However, I surely did feel connected.  I have found myself telling this story so others may also be attentive to those times when chance encounters can lead to break the silence.  Out of the whisper a truth was spoken that led from vulnerability to strength.

Alan Johnson

 Interfaith Network on Mental Illness

 

Sibling Support – What’s Out There?

As a child growing up I never thought about the concept of needing “support”. I didn’t think about the fact that I didn’t know anyone who was experiencing a lot of the things that I was experiencing in my home. Maybe I did have friends who were also sibs to special needs kids, but if I did, I didn’t know it, because I was not aware that there was a need and so I didn’t talk about it. I was a kid trying to be a kid, plain and simple. I had no idea of the concepts of peer support, the need for validation, or a safe forum to ask questions that I had about my brother’s disability or what it meant for my family, for me, or our future.

It was when I got older, working in the fields of both mental health and developmental disabilities, that I felt a kinship with the siblings, admittedly more so than with the parents of the special needs’ kiddos, or even the person with the special need him or herself. It started to happen naturally, and frequently, that I felt good when I could tell it helped them when I said something that clicked – I would often get a look which I translated as “Oh wow, you understand?, “You get this??”, or “This is comforting”. And then they’d be on their way, or I would … out the door, and then I worried they’d be back in a void; a place where they could not speak openly or feel as heard. At that point I realized my life had been a bit different than my peers and that it sure would have been nice if someone had understood, and that things should change.

I then reached a point in my career where I felt fairly secure or grounded in how I would approach sibs and was lucky enough to make talking to them about these things a small piece of my work. But I also became obsessed with finding out what else was out there. What kinds of groups? Doesn’t anyone else realize this is a need? And I researched. What I found was both thrilling, and disappointing. There is very little available, which saddens me. It is still a field untouched and undiscovered, really. However, I also found The Sibling Support Project, and Don Meyer; someone who not only knew the need very well, but the man who took the extra leap and created the curriculum for Sibshops. Eventually, I took his workshop and now am a facilitator of these Sibshops in Colorado Springs, Colorado. There are many around the world. Below are a couple of links, with explanations of this issue, the need to address it, what Sibshops are, and how to find them. I highly encourage you to surf around, wherever you are. There may be a Sibshop near you, and if not, you may want to make it known to a local organization that you wish there was, and that you would want to partake in that service if it was available. Maybe you want to take the workshop and then facilitate them yourself! It is highly rewarding, FUN, challenging, and affirming.

http://www.siblingsupport.org/
There are so many places to go within this site. If you are a sibling of a special needs’ person, you could be here endlessly. Pay it a visit.

Some options:

You may click on “Sibshops”, then “Find One Near You”, and enter your country and state and see what pops up.

Or click on “Connect With Other Sibs” and find the various stories to read and maybe connect with, and there are also some very active online forums for sibs to join.

There are books under “Publications” (which can be life-changing; one in particular was, for me), or click on “Workshops” to see if a facilitator training is coming to your area.

www.rockymountainsibshops.com
A shameless plug at my own website, should you happen to be in the Pikes Peak region…. Even if you’re not, I invite you to click on “External Links” for some good Youtube videos and recommended publications which might serve you.

I have seen some change in the past year or two. I give most of that credit to Don and The Sibling Support Project, for raising awareness, and to the work of Sibshops’ facilitators in so many communities. It is a healthy start. There is so much need, and so much more room to grow. Please get involved. Chances are if you are reading this blog, you are involved at some level. I hope the importance of sibling support is ringing true with you and that you will seek it in your community and consider getting involved.

Lisa Croce, RN, BSN

www.rockymountainsibshops.com

 

Confidentiality Barrier

I hear many families complain that, when their relative is admitted to a psychiatric hospital ward, they can’t get basic information about him or her when they call the hospital. They are told that the information is confidential and protected by statute. What a frustrating situation for the family and what an obstacle to good patient care this must be! Common sense and common courtesy, at least, should tell the hospital staff that each patient, upon admission, should be asked if he or she would be willing to sign a release of information form allowing staff to communicate with specific family members. New patients are asked to sign plenty of forms. This could easily be one of them. This is rarely done, however, in US hospitals and clinics. Why is this so? Is it laziness, because talking to families takes time? Or is it a reflection of the often unrecognized stigma that even mental health professionals harbor inside?

We have to recognize an important element in this situation. In the US, hospital administrators and their lawyers are running scared since the introduction, in 1996, of the federal HIPAA Privacy Rule that prevents service providers (with heavy fines) from releasing confidential health-related information. At the same time, the Privacy Rule is balanced so that it permits the disclosure of health information needed for patient care and other important purposes. A simple release of information form signed by the patient, or the existence of an emergency situation that over-rides confidentiality, can satisfy the needs of the family, the service providers, hospital administrators and lawyers alike.

Whatever the underlying motivation, if you run into this situation, you need to know that, even without a signed permission to release information or the existence of an emergency situation, communication is still possible. You can always give information to the staff that they should have if they are to be able to understand their patient and to treat him or her properly. You can tell them, for example, about your relative’s behavior prior to the hospital admission that they may not know about because he or she is too guarded to mention it. You can tell them about your fears, your concerns, or what a wonderful person your relative is when not afflicted by illness.

Here is what the well-known American psychiatrist Robert Liberman has to say about this issue in his 2008 book, “Recovery from Disability”:

“Too many practitioners pay obeisance to a misguided conception of privacy and confidentiality. There is no violation of confidentiality when a clinician solicits information from family members. Can anyone picture an internist or surgeon failing to invite a close family member to provide confirming and converging information regarding the patient as a key element in diagnosis and choice of treatment? Relatives are lucky if they get in to see the professional responsible for the patient’s treatment, much less hear of the patient’s diagnosis and prognosis. Plainly speaking, relatives are ignored by mental health professionals.”

What can you do if you find yourself in this situation?

Number one: Be assertive. It is your right to know what is happening with your loved one. Take a stand!

Two: Ask the staff to ask your relative to sign a release of information allowing them to talk to you. Failing that, ask your relative to ask the staff to give him the same form to sign. If your relative declines to do this on Day One, ask again on Day Six or Seven.

Three: Remember, there is no law that prevents you from giving information to anyone on the hospital staff if you think it would be useful.

Four: Expect to be included in post-hospital discharge planning unless your relative specifically objects to your inclusion.

Let’s bring some sanity back to the mental health treatment system.
Dick Warner

 

Social Therapies

In the USA in the 1960s, the era of the Civil Rights Movement, the rise of Feminism, and President Kennedy’s Community Care policy, psychoanalysis became a country-wide fad. Much of Woody Allen’s humor was based on poking fun at psychoanalysis. More significantly, a personal analysis was an essential requirement for a chairperson of a Department of Psychiatry. Over the next several decades the pendulum swung away from psychoanalysis towards biological explanations for psychiatric disorders, partly as a result of technological advances in brain imaging and genetics, but also due to the campaigning of the large and powerful pharmaceutical companies. Today psychoanalysis is almost extinct in the USA. The emphasis on an exclusively biological basis for schizophrenia generated a mind-set inimical to the notion of recovery.

There was never such a wholesale commitment to psychoanalysis in the UK, where the number of analysts has not exceeded several hundred for a population of 55 million. Furthermore the majority of analysts live in the major cities, and there is only a handful in the north of England. The dominant ideology in mental health has been a social approach, the pioneers of which were active from the 1930s, establishing community services before the advent of psychotropic medication. The founding of the National Health Service in 1948 provided a basis for social therapies such as rehabilitation, with an emphasis on recovery from psychiatric illnesses including schizophrenia. From the 1950s onwards, successive governments of both the Right and the Left supported a policy of deinstitutionalization, which has been effective in reducing the number of psychiatric hospitals in England and Wales (Scotland has its own Department of Health) from 130 to less than a dozen. The discharged long-stay patients are living in much improved conditions with greater freedom, and there has been almost no homelessness, or victimization.

The emphasis on a social approach in the UK has led to important advances in the non-pharmacological treatment of schizophrenia. These include professionals working co-operatively with family careers and patients, with a reduction in relapse for the most vulnerable patients from 50% over 9 months to 10 %. British psychologists have adapted cognitive behavior therapy, developed in the US for depression, for the treatment of schizophrenia, with a reduction in delusions and the distress due to auditory hallucinations. Recently a computer-assisted therapy has been developed for the treatment of auditory hallucinations resistant to medication, which has been effective in reducing the frequency, volume and malevolence of the voices in many patients. A minority even ceased to hear the voices altogether. These social therapies do not abolish the need for antipsychotic medication, but are free of side effects and produce improvements in the symptoms that enable patients to re-establish productive and satisfying lives.
Julian Leff

 

“What We Siblings Have in Common, Besides our Sibs”

We brothers and sisters of people with special needs, whether we are young, old, or somewhere in between, have much in common. Of course we are all individuals and as unique as everyone else on the planet, but there are some general traits and aptitudes that we tend to share. I would sure love to hear back from some of you after reading this blog to learn what you find to be true, how your experiences are different, and what your thoughts are as you read. Are you surprised? Are you validated? Do you get a feeling of “Oh, it’s not just me?”, or are you thinking “Hmmm, I am a sib and this doesn’t describe me at all”. Maybe you see another one of your sibs in some of the phrases. Please feel free to share.

There are three very typical behaviors taken on by children who grow up with a special needs’ sibling. We’ll call them “The Overachiever”, “The Invisible One” and the “Pick Me! Pick Me!”.

The Overachiever: Some sibs (it often happens to be the eldest, though not always) seem to try to overcompensate for the special needs’ siblings by working extra hard in school, being overly helpful in the house, behaving exceptionally well. They see that it is sometimes difficult for their parents to care for their sib, and so they do their part to make things easier. This sounds wonderful, and in many ways is, but hopefully these kids are having fun too, and not growing up too fast. One upshot of being The Overachiever is the good grades which may afford them scholarships and invitations to good colleges and universities.  Another is possibly a lower risk lifestyle and safer adolescence with less chance of experimental drug or alcohol use, or young onset of sexual activity.  The bad news is the self-induced pressure and high standards which might be difficult to maintain, and depressing when they can’t be lived up to. This is still a child we are talking about, after all.

The “Invisible One”: For the same reasons as The Overachiever, The Invisible One just figures if they fly below the radar it will make their parents’ lives easier.  They may, unfortunately, be feeling an absence of attention from their parents since much of their focus is on the special needs’ sib, and so they feel a bit invisible, and then simply behave in a way that lives up to that persona. They’re not getting into lots of trouble, or failing in school, yet they’re not stand-outs either! They simply go along, hardly recognized, and are sometimes referred to as  “easy” children. The good news, again, is possibly lower risk behavior, getting into very little trouble at home and in school. The bad news is maybe these children are not living up to their fullest potentials, or as happy and fulfilled as they could be. Maybe they want more out of life, or from their parents, but do not seek it because this would certainly make them visible.

The “Pick Me! Pick me!”: Oh boy, this can be a fun child. Often described as precocious, incorrigible, one who stands out from the rest of the family, or simply –   trouble, this child wants to be noticed and plain refuses to be ignored! They may at times realize their parents’ attention is being directed to where it needs to be, and simultaneously feel badly or guilty for interrupting that, however, they also feel a compulsion to be noticed; to want to be “picked”. The good news is that they are strong-willed, which is a quality helpful in later life in terms of assertiveness and getting their needs met. It may, in fact, gain them the attention from their parents that they need. It gets them noticed alright! The downside is that they sometimes don’t mind if it entails breaking the law, doing badly in school, acting out at home. They simply WILL be noticed.

Of course all kids, regardless of whether or not they have a sibling who has special needs, may fit into one of those three types, or another type. In addition, so many other factors in a person’s life affect their coping styles, including whether or not they are from a two-parent household, examples set for them, birth order, etc. The point is there are surely some general commonalities, and I point them out because it can be enlightening for a sib to know this, and to determine or gain some insight as to why they behave the way they do or became the way they are. I was a “Pick Me” kid and I did not end up in jail. I did, however, give my parents a run for their money. I think, and sure hope, that now they would be proud of the way I’ve turned out. I mention this to point out that it is not always a negative thing. Kids learn to cope in various ways. It just is what it is.

Special needs’ sibs learn and experience their family life in ways that most kids don’t. Empathy is often a lovely outcome. Most sibs are not only compassionate, but are also quite open-minded and tolerant of people who aren’t “typical” in myriad of ways. They don’t tolerate bullying. A high percentage of sibs grow up to find themselves in the helping professions (nurses, teachers, therapists, physicians, etc). I think sibs are special and make the world a better place. It is my hope that you will communicate with each other, meet each other, find support and understanding in each other, thereby creating a better understanding within yourself, and feel less alone in the world. In my next blog I will discuss the current available supports to encourage this. Please stay tuned and consider reaching out.

Lisa Croce, RN, BSN

www.rockymountainsibshops.com