The Recovery Network

by Thomas M. Gonsa

The Recovery Network is an innovative program at the Central New York Psychiatric Center that may have applications throughout the mental health system.

After reading a recent “Mental Health E-News” posting offered by the New York Association of Psychiatric Rehabilitation Services (NYAPRS) concerning the state of Georgia’s Certified Peer Specialist project, I felt the need to inform NYAPRS and as many mental health professionals as I could about the innovative and groundbreaking rehabilitation program offered at the Central New York Psychiatric Center (CNYPC).

Similar to the Georgia program, the program at CNYPC serves patients within the rehabilitative process, but that is where the similarity ends.

CNYPC’s clientele are not only patients, but they are also inmates within the New York State Department of Correctional Services. As I am sure you are aware, a community consisting of not only prison inmates, but of inmates who suffer from major mental illnesses, can be quite confrontational and violent. This is especially true for newly admitted patients. Developing an effective recovery model offers many challenges and requires a great amount of patience.

The facility’s Executive Director and the Director of Inpatient Nursing along with their cabinet members charged the facility’s Rehabilitation Director with the responsibility to create and implement a new and effective rehabilitation program.

Recognizing the importance of peer on peer recovery, the hospital implemented, “The Recovery Network.” This network continues to evolve and is always open to, and in fact encourages, patients to suggest, create, and/or facilitate programs to assist their peers in learning about their mental illnesses, understanding and taking control of the symptoms of their illnesses, and learning and employing various coping skills.

The Recovery Network is the foundation of the hospital’s vision for rehabilitation. The network consists of four main components. Each of these components is based on the premise that a person who is diagnosed with a mental illness and working on a positive recovery program will be, and is able, to assist others in similar circumstances. All four components involve peers helping peers through role modeling, encouragement of treatment compliance, and offering nonviolent solutions to problems. (See the chart).

The Patient Program Assistant (PPA) is selected through a recommendation and referral from his or her Primary Therapist and Treatment Team. The candidate must not be housed in the correctional facility’s Special Housing Unit (SHU). He or she must have a high school diploma or GED and be working on a positive recovery program. Patients who are interested in the position must understand that they are expected to be positive role models for their peers.

PPA’s are trained at CNYPC by experts and consultants associated with the State of New York’s Office of Mental Health. They receive training in a variety of areas including, but not limited to, group dynamics, communication skill, anger management, stress management, conflict resolution, various mental illnesses, symptom management, medications and their effects.

The duties and responsibilities of PPA’s are many and are geared to each PPA’s general area of expertise. Some duties include co-facilitating various groups and training sessions. They orient new patients as well as new staff members, assist staff in their interactions with patients, act as peer advocates, set an example of nonviolence and medication compliance, assist with various self-help programs, help create, develop, and implement new therapeutic programs and train new PPA’s. The PPA position is a one year position. At the conclusion of this period of service, the PPA’s Primary Therapist will begin to implement his or her discharge plan. The goal, established by the Executive Director, is to place the graduating PPA’s into the Department of Correctional Services’ and Office of Mental Health’s dually run Intermediate Care Program (ICP) where they will be able to apply the skills they have acquired through their training.

ICP’s are programs available in New York State’s Maximum A Correctional Facilities for inmates with mental illnesses who, because of their illnesses, are unable to function within the facility’s general population. The ICP’s offer a safe and therapeutic environment where inmates can live and maintain a recovery program.

Another component of the network is conflict mediation. Prior to the implementation of this component, most conflict resulted in emotional, physical, and/or verbal confrontations requiring patient separation, patient seclusion and the use of mechanical restraints.

Through the development of this patient-staff program, group members who are designated as conflict mediators are trained in the skills needed to resolve conflict in positive, nonviolent ways.

Group members meet weekly to review the past week’s mediations, learn and discuss the many various nonviolent ways to resolve conflict, receive training in mental illnesses and their symptoms, develop strategies to work with “difficult” people, and improve the skills necessary in decision making. Members also practice their mediation skills through the use of role plays and group discussion. Conflict mediation is advertised throughout the hospital by the use of posters and word of mouth. It is also introduced to newly admitted patients at a weekly peer orientation group.

Patients are continually informed that they are patients in a hospital. They are no longer considered prisoners. Through the use of positive peer pressure it is explained that the hospital staff members are not correctional officers. Patients are informed that the staff is here to help, and they can and should be trusted. As a result, patients become willing to learn about, and to solve their conflicts through the use of new nonviolent ways such as conflict mediation.

It is the purpose of conflict mediation to offer patients a new, safe, and effective way to resolve and overcome conflicts. The program offers parties in conflict the needed privacy to explain each side’s conflict completely and without interruption. It creates a forum that allows the participants to work toward, and arrive at a meaningful solution together. It is stressed that all conflicts can be mediated. Any patient who is interested in becoming a conflict mediator must request a referral from his or her Primary Therapist to the Conflict Mediation Work Group.

Since the implementation of Conflict Mediation, there has been a major decline in all forms of conflict. As a result a much safer environment has been created which is more conducive to the recovery process. The atmosphere creates a sense of calm and trust that is necessary for the patient to begin the journey to overcome his or her illness.

The oldest component of the Recovery Network is entitled Central Insight. Central Insight began approximately five years ago as a peer counseling group that dedicated itself to working with their peers who are high users of restraints and seclusion. CNYPC found that by offering high users a forum where they can discuss their problems with their peers, the need for restraint lessened dramatically. The hospital learned that peers were more apt to listen to and accept help from their peers.

As the group evolved it composed a program for [orientating omit DN][orienting DN] not only fellow patients but also newly hired personnel of the Office of Mental Health. Members of Central Insight continue orienting new staff about patients’ rights and responsibilities and the many therapeutic programs offered throughout the hospital.

The newest component of the network is entitled, Each One Teach One (EOTO). This segment of the recovery network emphasizes individual therapy on a one-to-one level. Each of the hospital’s PPA’s seeks out a patient who for any number of reasons may need a more direct form of therapy. The PPA becomes the patient’s advisor, teacher, advocate, and most important, friend.

Many lower functioning patients are forced to live on the edge of their community by their peers. This occurs because many higher functioning patients are not able to relate to them or understand them and, as a result, ignore or much worse, ridicule them.

With the addition of EOTO, the PPA’s are able to offer the lower functioning patients individualized support. He or she not only mentors the patient but offers the patient a shoulder to lean on and an ear to listen.

In a matter of weeks there is a very noticeable level of improvement. As a direct result of the attention and guidance offered to the patient, the lower functioning patient is brought into, and becomes part of the whole community.

In constructing the Recovery Network the hospital has recognized the importance of peers helping peers. By using patients to assist, instruct, and guide their peers, incredibly large strides in recovery are accomplished. In fact, miracles occur.

It is refreshing to know that professionals like those at CNYPC, are willing to learn and employ new methods of therapy. They have created the foundation for a positive recovery program that should be considered throughout the mental health field.