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The Los Angeles Days – Part Two

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To be frank, I was astounded, astonished and heartbroken that anyone would be concerned that Procovery might help people to heal. Why wouldn’t this not only be seen as a positive, but also as the collective goal?
It was shocking to learn that healing could be seen as a negative, but specifically by someone working in public mental health, and it was incredibly disheartening that they would not only be in touch with the concern, but possibly act on it by intentionally withholding legitimate tools for healing.
New residents moving into a home frequently come in directly off the street, in the midst of crisis mode. It takes considerable time to determine the best, most sustainable room-mate situation, if there is family involvement, how to support or foster family involvement, etc. Determining medical considerations is incredibly time-consuming and determining what medications and med routine work best for the individual is labor intensive. The time spent toward determining, and then supporting, dietary restrictions (due to allergies, medications, religious beliefs, etc.) is immense. It is very complicated to determine which staff will be the best fit to work with the new resident, which adult home activities they might benefit from, along with a multitude of other considerations.
The reasoning I heard, over and over, was that with new residents moving in, there becomes an economic deficit, due to all of the care and attention needed to stabilize them in their new home. It is only after the initial (and often lengthy) transition period that the funding received for residents actually covers all of the expenses, and once the resident is fully settled, after multiple attempts at room-mates and medication choices and routines and family contact and group activities, there is very little profit and that minimal profit is then contributed to the deficit experienced with future new and/or high need residents.
Administrators reasoned that if Procovery helped people move out (and move forward with their life), they would be left with a constant stream of new, high need/high cost residents and the home would be unable to stay afloat. It was a cycle that never ended.
I heard this over and over (although different factors, reasons and outcomes played in to each institutional setting and administrator’s perspective) and there were always strong reasons why helping people heal, beyond the institutional setting each administrator oversaw, would (by their logic) negatively impact the system over and over and would ultimately put them and their staff out of a job, and current and future residents — people who needed and deserved a place to live — out of options.
At that time, I began to understand even more about the depth to the intricacies and complexities of the system and how shockingly hard it is to navigate, on ALL sides.
Stay tuned for The Los Angeles Days – Part Three.
Until next time…
Kathleen
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The Los Angeles Days – Part One

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After our early days in Wisconsin, we partnered with Los Angeles County Department of Mental Health and University of Southern California, to further test Procovery Circles, and to test cultural efficacy, as well as the implementation of Procovery across institutional settings.
By then, we had learned a lot more about what was needed to support both the healing process, as well as Procovery Circles, but we also learned that implementation was often very challenging, for many reasons.
Early on, one of the hardest things to learn was how often, in state after state, the most caring and well-meaning of administrators would create barriers related to individuals moving forward, or would not remove them after becoming aware of them. One of many examples was in adult homes where administrators, very honestly, told me in a number of different ways that they were afraid that Procovery might help people heal.
Please check back soon for The Los Angeles Days – Part Two.
Until then…
Kathleen
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The Wisconsin Days – Part Six

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After The Power of Procovery was published in 2000, I began receiving requests for a guide to be written about implementing Procovery support groups. The need for a guide like this made perfect sense and seemed like it would be a huge complement to the manual, but I truly had no interest in doing this at the time. I was still working on a 100% volunteer basis and strongly planning to refocus on Health Action Network’s original mission, and this felt like an extension of work I thought was put to rest when The Power of Procovery was published. It’s very interesting that we sometimes cannot see that what seems like a door closing is actually a door opening.

After much thought, I finally agreed to move forward with the guide, as I had with the manual, and decided that I would approach it in the same manner as that project. I interviewed people who identified as having benefited from support groups throughout their healing process. I wanted to determine specifically what their experience had been with support groups along the way, including the negative, neutral and positive experiences. While we largely wanted to determine what had worked, we also wanted to remain aware of the commonality between what didn’t and why.

The process was, once again, far more complicated and challenging than I could have anticipated going into it. Again, synthesizing the seemingly diverse opinions and thoughts, that seemed entirely at odds with each other, seemed impossible. As had been the case while writing the manual, with my husband Randy’s immense help, I was able to identify the underlying patterns and find core elements to what people felt had helped, hurt and everything in between.

In 2001, I published Starting a Procovery Circle: Just Start Anywhere, the first in a series of guides*, and I began the process of speaking about and training on Procovery Circles in Wisconsin. I look back and am simultaneously surprised by just how much has happened over the last 17 years and also find myself wondering how it all went by so quickly. It’s been really wonderful to experience this journey in a different way, through the writing of this blog series.

While these blogs could go on forever, the point of this series was to merely crack open a door so that some of the behind the scenes breakthroughs, roadblocks and successes, could be shared. This concludes The Wisconsin Days. Next up in the series: The Los Angeles Days. We hope you’ll stay tuned!

Until then…

Kathleen

*While these guides are no longer available or in-print, this will be touched on during The Missouri Days part of the series.
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The Wisconsin Days – Part Five

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In order to write the manual on recovery, I decided that what I needed to do was interview people who had healed, often seemingly despite all odds, so I could better understand what they attributed their healing to. I then would need to talk to loved ones and staff, to gain their perspective. This, in itself, was a huge undertaking, but the most difficult time came after I completed these thousands of interviews. I was dumbfounded to find that there was seemingly no commonality — not just between the 3 stakeholder groups, but within them. There really did appear to be just as many paths to healing as there were to illness and it felt, for a time, as though every single person would need their own completely innovative and targeted plan for healing. While the idea of completely individual, tailored and targeted healing plans seems ideal, it also would mean that recovery would be impossible to implement systemically.

But, fortunately, with the help of my patient and dedicated husband, who by that point had taken a very demanding job outside of his contribution to Health Action Network, a commonality began to emerge from the thousands of index cards that were, by then, lining the rooms of our home in San Francisco. Each index card ended up being a crucial piece of the puzzle, but when you don’t see the picture of the puzzle before attempting to put it together, it can feel like an impossible task with endless possibilities. Ultimately, 8 principles (attitudinal) and 12 strategies (skills) emerged as the pattern and I spent day after day and night after night, turning this beautiful and complicated puzzle into book form.

The manual that felt absolutely impossible to write was published in the year 2000 as The Power of Procovery in Healing Mental Illness: Just Start Anywhere.

Please check back for Part Six, the final piece of the The Wisconsin Days series, soon!

Until then…

Kathleen

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The Wisconsin Days – Part Four

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We were focusing on finding our footing and settling into our new life in San Francisco when, very shortly after the move, I was contacted by the Bureau of Mental Health in WI and was asked if I would write the manual on recovery that I had mentioned at the Q&A that day. This was simultaneously a huge surprise, a massive honor and an incredibly overwhelming idea. We were very passionate about all of our work with Health Action Network, but we never anticipated it being as consuming as it had become. I was very conflicted by the invitation to continue down this path as the word/concept/program/materials of Procovery were never part of the mission of HAN, and I was really looking forward to returning to our original mission and focus.

In all honesty, I’d never actually considered or anticipated taking on the writing of the manual when I suggested it. I think people have the ability to be far more ambitious and visionary, and tend to feel comfortable to think on a larger scale, when they won’t be the one doing the actual work, which was certainly the case here. I saw this as a great idea for someone else to execute.

I took a bit of time to think about the possibility of taking this on and I finally came around to seeing this as an extraordinary opportunity to make meaningful systems change, which was the entire basis for all of the work I’d been committing myself to. This became an idea that I just could not walk away from and I finally agreed to create the manual.

Not only did I not think all of the specifics through, I truly had no way of knowing at the time what the specifics would be, how I would approach this project, and ultimately, how profoundly challenging I would find the experience of turning this Q&A response into a reality.

 

Please check back for The Wisconsin Days – Part Five!

Until next time,

Kathleen

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The Wisconsin Days – Part Three

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Our personal life was thriving and so was our work through Health Action Network, but while our family loved Wisconsin and the amazing people we’d come to know, we were all a bit homesick. Shortly after the Wisconsin Blue Ribbon Commission on Mental Health Final Report was published, we relocated back to our home state of California, this time to San Francisco.

Prior to the move, I was asked to give a talk at an event for the Bureau of Mental Health in WI, and during the Q&A session after the talk, I was asked what I felt would be the recommended next step in recovery implementation in the public mental health system. I replied that I felt a shared manual on recovery was needed, one that crossed stakeholder groups and applied to consumers and loved ones and staff. While it was a short response to the question, it was a BIG idea and I knew that.

The response to my answer is something I will always remember, as the idea was, ever so clearly, NOT well received by those in attendance and many, many (understandable) objections were voiced. I made it clear that while I did understand and appreciate the objections, I remained steadfast that if we were to share a common concept, and vision and objective,we ought to be able to share one common book. It seemed simple and straightforward, but I was careful to make it clear that it was my belief, my opinion and my response to one question at one Q&A session after one talk.

 

Please check back in a couple of days for The Wisconsin Days – Part Four!

Until then,

Kathleen

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The Wisconsin Days – Part Two

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Shortly after the Psychiatric Rehabilitation Journal article was published (in which I first used the word Procovery), I was asked to give a keynote speech and lead a workshop on the concept of Procovery at the NYAPRS annual conference in New York. As I previously mentioned, there was no Procovery concept. It was simply a word created out of necessity, to assist in conveying a much larger point. But, I was intrigued by the idea of a broader scope and put some thought into whether or not a concept, based on a word I made up, was even possible. I ended up investing a large amount of time into the development of an initial overview of a concept that aligned with the word, and was surprised by how big it was becoming. It was like opening a door to a room no one knew existed and then no one is sure how it was missed for so long.

After the conference, I had the privilege of being invited to join the Wisconsin Blue Ribbon Commission on Mental Health and was subsequently asked by Sinikka McCabe (now Santala), the Director of the Bureau of Mental Health at the time, to write an article on the Concept of Recovery for the Final Report of the Blue Ribbon Commission on Mental Health. Below are a couple of excerpts from that Final Report from April 1997.

 

3. The focus of a recovery-oriented mental health system makes financial and therapeutic sense

How can we possibly afford to offer the resources necessary for individuals with a chronic illness to recover? In truth, at a time when cost control is critical, how can we not? Recovery is an everybody wins scenario. In a recovery-oriented system, mental health consumers rebuild meaningful lives while decreasing their dependence on the system. From both a therapeutic standpoint as well as an economic standpoint there should be little confusion in this regard. Rather than creating long term users of a system that fosters dependence, individuals will receive services that will enable them to recover and decrease their dependence on the system.

 

5. Summary

Recovery must not be used as a buzz word for cutting critical services. Such cutting will only increase the long term usage and and costs of the mental health system. Rather, it must be recognized that (1) as with chronic physical health issues, treatment requires the availability of an effective complement of “medical” and “rehabilitative” services and (2) all services must be delivered in a new manner with a focus on the basic principles of recovery.

In essence, the elements critical to bringing about recovery on a large scale are not costly or complex. Teilhard de Chardin said, “The focus is not to do remarkable things but to do ordinary things with the conviction of their immense importance. ” Mental health consumers want what everybody else wants. They want a home and loved ones, and to continue to grow as they age. They want their lives to have meaning. They do not want to die, never having lived.

A recovery-oriented mental health system moves beyond the focus of surviving and develops the focus on thriving. A mental health system must adopt a recovery-oriented delivery of services. It cannot afford to do otherwise, therapeutically, economically or societally.

As a reminder, these pieces of writing are from twenty-one years ago, yet still apply today.

Check back for the continued overview* of the evolution of Procovery. Next up, The Wisconsin Days – Part Three!

 

Until then,

Kathleen

*This blog series is quite a brief overview, with much left out for consideration of the reader’s time and patience.
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The Wisconsin Days

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To rewind a bit, it was the year 1996 and we were living and working in Wisconsin. My (late) husband, Randy Stratt, and I founded an all volunteer 501(c)(3) non-profit organization, Health Action Network, which was dedicated to informing, empowering and inspiring individuals to become more involved in their health care. By providing community forums, surveying people across the state, holding town hall meetings, providing educational workshops, publishing a newsletter and spending countless hours (which turned to weeks and then to months and beyond) advocating for people to ask questions, seek second (and third and fourth) opinions and place real focus on choices regarding medications and treatment, we diligently sought to inform, empower and inspire people to become more involved in their health care, and to become active participants rather than passive recipients.

Health Action Network’s work wasn’t specific to mental health care – that integration and focus would come later. At the time, though, I was writing an article for Psychiatric Rehabilitation Journal and struggling to find a word that conveyed what I was attempting to address in the article. Frankly, I was stumped. Nothing worked or even really meant what I needed a word to mean. It was an incredibly strange place to be as a writer, needing a word that didn’t exist yet. Procovery came to me in a brainstorming session and I finally settled on it, not feeling that I had many other options. Procovery, a word that meant absolutely nothing to anyone as it wasn’t even a word at all, resonated with me enough to move forward, at least for the writing of the article. I thought it might end up being a space-filler, a stand-in, that would help me illustrate my point. It wasn’t anything beyond the word at the time, but what would come, the development of the concept and all that followed, were not something I could have fathomed.

Below is an excerpt from that article, What is Possible in Psychiatry: Five Psychiatric Steps That Mattered, published in the Spring 1996 edition of Psychiatric Rehabilitation Journal (Volume 19 Number 4), containing the first use of the word, Procovery, that would come to change the course of my life’s work.

As William Anthony (1993) describes, “Recovery involves the development of new meaning and purposes in one’s life as one grows beyond the catastrophic effects of mental illness.” It may be that the general meaning of the word recovery stands in the way of this powerful concept; perhaps a new word such as procovery might be adopted to refer to the recovery of a productive life regardless of the level of health attainable.

 

Thank you, all, for taking this look into the early days with me. Stay tuned for The Wisconsin Days – Part Two!

 

Until next time,

Kathleen

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New Blog Series

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Procovery Institute has been very quietly, and for the most part behind the scenes, testing, revising, updating and improving the Procovery program for over twenty years now – you could say we’ve been taking the slow and steady approach to program creation and implementation, but it honestly hasn’t always been steady.

Despite strong interest in the program from the very beginning, we have always been firmly committed to ensuring fidelity, above all, before we could offer the program to a far broader population. Toward this end, we have some exciting things planned this year but, first, we are going to offer a bird’s eye view of the last 20 years in this new series of blogs, taking you back to where it all started, how it all started and the ever-changing path that provided many challenges, many rewards and profound outcomes.

Please check back for our next blog, the first step inside our journey.

Until then,

Procovery Institute

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Instructions for Living a Life

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Instructions for living a life
Pay attention
Be astonished
Tell about it

 -Mary Oliver

 

Happy Friday, Procovery Community! We hope you live a lot of life this weekend!