CAREGIVERS PLANNING FOR WHEN THEY ARE GONE – A CAREGIVER FOCUSED APPROACH

The Mental Illness Caregivers Association https://www.micaontario.com/ planning discussion document is aimed to develop more effective approaches that both strengthen and maintain continuity of care and address future needs.  It is drawn from the perspective of family caregivers.  It resonates and benchmarks with —the key components of the Recovery Model and the current Ministry of Health standards of community care provided by: Intensive Case Management and Assertive Community Treatment.

The discussion document has a “Planning Framework” to address core needs and has an emphasis on the financial and housing resources family members use to support their family member for the future, “after we are gone.” MICA identifies the need to develop organizational partnerships in order to implement good care and build a community based and care system approach for people living with mental illness, substance abuse and developmental disabilities.

… it is now more urgent than ever for the Ministries of Municipal Affairs and Housing, Health and Long-Term Care and Children, Community and Social Services to work together to ensure all caregivers have a housing plan that addresses both current and future housing needs of the most vulnerable in our community …

It strikes me that this effort by family members to support their loved one’s, can bring the rest of us along to strengthen communities and services for all of us.

Please provide your thoughts and engage with planning discussion document here: https://www.micaontario.com/HousingPlan.php

(image: photograph of a large group in park with banner stating: we walk with you)

MENTAL ILLNESS CAREGIVERS ASSOCIATION (MICA)

NO ONE WALKS ALONE, WE WALK WITH YOU

Clearing the air on the basic status of care for people living with “severe, persistent mental illness” and addictions in Canada

What ever your view on the weakness’, strengths and follies of adult psychiatry, David Gratzer’s https://davidgratzer.com/ article  A crisis of neglect: How society can help those with mental illness address’ the current status of care services, the need to address the social determinants of health, along with involuntary treatment initiatives for mental health and addictions in Canada.

Its all been said before but to his credit the doctor’s plain speaking assessment brings us to the basics for people living with “severe, persistent mental illness” and addictions.  This article makes it less easy for the neglect to be nudged aside by government news releases of their newest programs.  But what made me sit up was his concluding section, it shifts our view from an individual’s recovery to what surrounds them in their community.

… Dr. Thomas Insel, a psychiatrist, led the U.S. National Institute for Mental Health (NIMH), the largest funder of mental-health research in the world, for 13 years. He’s advised American presidents and overseen US$20-billion of funding. He marvels at the incredible advancement in scientific knowledge when it comes to mental disorders. But he also sees deep problems. In a recent conversation, he explains: “In the years I was at NIMH, the suicide rate in the United States went up 30 per cent, and overdose death went up 300 per cent. The numbers of people with serious mental illness who were working, who were housed, who were not incarcerated, all those numbers went down, not up.”

How to address our current problems? He talks about the advice he received from a psychiatrist who works with the homeless. “‘If you really want to make a difference, stop thinking about diagnosis and symptoms, start thinking about recovery.” He said, ‘it’s simple. It’s just the three P’s.’ And I thought: Prozac, Paxil or psychotherapy. He said, ‘No, it’s people, place, and purpose. Social support, a decent environment with housing and food and things that help people to prosper, and people will have to have something to live for.’” …

Here is the article: https://www.theglobeandmail.com/opinion/article-a-crisis-of-neglect-how-society-can-help-those-with-mental-illness/

A resource for strength based interventions

The British, Social Care Institute for Excellence (SCIE) https://www.scie.org.uk/ provides a set of training resources that take a community focused and care system wide approach at: individual and organizational levels with potential policy impacts if deployed well. Refreshingly, it incorporates but moves beyond the individual clinician.

A strengths-based approach…

… a simple phrase that has different meanings for different people but an approach
that when done right, opens up many possibilities.

A strengths-based approach can be used in any intervention, in any setting, with
any client group, including carers, and by any social or health care member of staff.

Please go to the site, here: 

https://www.scie.org.uk/strengths-based-approaches?utm_campaign=12459177_SCIELine%2016%20June%202021&utm_medium=email&utm_source=SOCIAL%20CARE%20INSTITUTE%20FOR%20EXCELLENCE%20&utm_sfid=003A000000bleejIAA&utm_role=Social%20worker&dm_i=4O5,7F1K9,UW4G3,U4NGB,1

A refocus on Institution’s roles in community health and justice, … we have a choice to make

Cormac Russell https://www.nurturedevelopment.org/who-we-are/cormac-russell/ in “Does more medicine make us sicker? Ivan Illich revisited” helps us to refocus on our efforts to improve individual care and advance system and social change through our organizations and institutions as the drivers of change. For me the practices of implementation science, has greatly brought needed light, tools and analysis to pulling organizations towards practice change. It includes ideas such as co- production as well as keeping an eye on “the external” systems. This article reminded me to shift my institutional interventions mindset to reflect, analyze and cherish community.

Title of article, Does more medicine make us sicker? Ivan Illich revisited

… While Illich was opposed to institutionalism, he was not against institutions per se. Rather his pamphlets challenged attempts on the part of institutions to monopolize functions related to the production of health and well-being, death, safety, wisdom and justice. Since, he contended, these social goods were not commodities unilaterally produced by institutional systems and thereafter consumed by individuals. Instead, he notes in Tools for Conviviality, there are certain irreplaceable functions that natural communities must perform to be well and to prevail culturally.10 And, if they do not do those things, then there are no institutional tools or systems’ alternatives that can appropriately replace those civic functions.

Indeed, Illich argued that it is not a case of ‘either/or’ (community or institution), so much as a question of, which comes first. He contended that an institutional inversion had taken hold in modern societies, through which the community role becomes that which is left after the institutions and their professional helpers have done what they think they can do better or more expertly. Illich contested this inversion, and argued for its reversal whereby the institutional and professional role should be defined as being that which is left after the community has done what it can and wants to do. …

See the article here: /https://www.nurturedevelopment.org/news/does-more-medicine-make-us-sicker-ivan-illich-revisited//

Does more medicine make us sicker? Ivan Illich revisited

Deinstitutionalization is examined at an international level by the Committee on the Rights of Persons with Disabilities

Tina Minkowitz, Esq. of the Center for the Human Rights of Users and Survivors of Psychiatry http://www.chrusp.org/ in this article frames the initiative through a reparations approach and includes a call for sharing the experience. It also helps us to think more about current practices of institutionalization despite all of our intentions on community based care.  I know many groups in Ontario have been working to shine a light on this, even in recent years, in the context of homelessness and housing etc. 

Does anyone know if here in Ottawa they are linking with this report?

… The Committee on the Rights of Persons with Disabilities has announced a series of regional consultations on deinstitutionalization, starting with one for Central Asia and Eastern Europe on February 25 and a second for Central and South America on March 1.  The other regions will follow.  You can read all the details in an information note here.

This is an important opportunity for survivors of psychiatric oppression (if you are still alive and struggling as a current victim, I consider you a survivor, along with those who have gotten out) and our allies to make sure we are heard.

Victim’s perspective or system’s perspective?

Too often ‘deinstitutionalization’ has meant community-based mental health services, instead of freedom and acceptance, instead of recognition that we return from hell as survivors, that ‘survivor’ isn’t a euphemism.  Deinstitutionalization initiatives tend to take a service-provider point of view, seeking to rearrange their own territory in response to criticism of severe and egregious abuses.  We need instead to start from the perspective of victimized persons, acknowledging that the human rights violations go wide and deep, that they are systemic and cannot be rooted out unless we unseat the ‘service providers’ who have as a class been the perpetrators of these violations from directing repair.  Similar to the approach of feminists who insist on the personhood of female human beings – autonomous, not the negation of males or their perspectives but something entirely different – we need to start as victims of psychiatric oppression, looking at our reality – as individuals as collectively in our countries, localities, communities – and naming both the violations and what we want as remedies.

Of course our movement has been doing this since its beginnings, and we now have the excellent resource from our early days as a liberation movement, …

Please see the article here: https://www.madinamerica.com/2021/02/crpd-reparations-approach/?fbclid=IwAR2gPKJEffnCXjGHCeUWD-h5xDNFMzAkFOm1BwZEvgi6Gpef0tlLx0NKLdk

 

“Bits” of social work practice in the community mental health system — everyday psychiatric care and reform directions to advance the recovery model

Mental Health has a broad and socially woven meaning depending upon where you sit.  I work with people who have needed extended support to address and manage the disability of a mental illness. These are people who in their personal history need the most intensive levels of support from hospitals or community-based levels of mental health care.

This form and intensity of service is from a particular view and while vital to contribute to any appreciation of a whole population approach to mental health, its position on the continuum of care can skew our view of population-based mental health wellness. Especially with our legacy of institutionalization which to this day haunts my everyday practice along with the legacy of a poorly managed de-institutionalization process. At the same time, there are significant service changes in play.

This change is occurring across care disciplines as well as at academic research and professional levels. The Canadian Mental Health Association’s Framework for Support of a few decades ago led by former Centre for Addiction and Mental Health social worker John Trainor, does a very good job of depicting the complex dynamic.

(Image by Canadian Mental Health Association (CMHA) Peel-Dufferin)

See the Framework here: https://cmha.ca/documents/a-framework-for-support

Social Work’s ethics, values and knowledge base bring critical pillars to community-based care and recovery practices. The bio/psycho/social practice of care which every psychiatric service posits as its framework of care continues to be the central focus. Yet, it has countless competing interests and problems in its implementation across the institutional and community systems of care encountered by clients, families and practitioners.

In 2005, the Canadian Association of Social Workers (CASW) provided a Summary of Core Social Work Values and Principles relevant to community practice in mental health.  https://www.casw-acts.ca/en/Code-of-Ethics%20and%20Scope%20of%20Practice

They are the following:

Value 1: Respect for the Inherent Dignity and Worth of Persons
 diversity, oppression and privilege; informed consent, client decision making, client rights and responsibilities

Value 2: Pursuit of Social Justice:
 social determinants of health, income distribution, discrimination, marginalization, policy and social/organizational structures, antiracism

Value 3: Service to Humanity
 use of power and authority, knowledge and skills, development of a just society, assessment and intervention techniques/approaches (individual, group, social), international linkages

Value 4: Integrity in Professional Practice
 professional practice and integrity, promoting values of the profession within organizations, neutral/non-neutral use of self in professional comportment

Value 5: Confidentiality in Professional Practice
 informed consent, transparency of process

Value 6: Competence in Professional Practice
 ongoing research and knowledge development for the profession, individual continuing competency, schools of social work.

My everyday practice covers long-term involvement with clients to advance community inclusion. Ronald Labonté of the Globalization and Health Equity Research Unit (http://www.globalhealthequity.ca/) of the University of Ottawa Institute of Population Health examines the concept of client empowerment when providing care in Health Promotion and Empowerment: Practice Frameworks (1993). He makes an important point in the context of “empowerment” where both client citizenship and support for personal agency through the community development process are occurring along with the clients themselves needing both direct service and care. He notes:

“The two pillars that allow service delivery to be empowering are, first, that is offered in a supportive, non-controlling way and, second, that is not the limit of the resources offered by the agency. The combination of these two pillars has been referred to as “developmental casework.” In contrast to more traditional forms of casework or case management, “developmental casework is developmental, with an explicit goal the development (empowerment) of the individual receiving the support, and the creation of links between these individuals.” This approach builds towards community organizing and coalition advocacy – and hence the political elements of empowerment at the structural level remain explicitly…people have the right, here and now, to support in the face of difficulties… “ (p. 61)

LabonteHealthPromotionandEmpowermentReport (1)

In social work, the well-known practice wisdom is that our moral distress and/or burnouts are more often about the politics of systems rather than the people we serve. A useful resource for my own impatience was developed in Great Britain to support practitioners in addressing social inclusion and stigma via a personal competence guide: Capabilities for Inclusive Practice (2007).

Click to access capabilitiesforinclusivepractice.pdf

The social inclusion capability framework comprises:

ESC1 Working in partnership
ESC2 Respecting diversity
ESC3 Practicing ethically
ESC4 Challenging inequality
ESC5 Promoting recovery
ESC6 Identifying people’s needs and strengths
ESC7 Providing service user-centred care
ESC8 Making a difference
ESC9 Promoting safety and positive risk taking
ESC10 Personal development and learning

In psychiatric care, control and self-control are critical aspects of care. The idea of Citizenship remains a historical and current area of practice focus. John Sylvestre of the Centre for Research on Educational and Community Services (CRECS) (https://crecs.uottawa.ca/) suggests in his book, Housing, Citizenship, and Communities for People with Serious Mental Illness, in the chapter entitled, “The contributions of the concept of citizenship to housing practice, policy and research,” that:

1) legal citizenship – individual in a political community,

2)normative citizenship – civic or social organizations, and

3) lived citizenship – daily life, need to be integrated. Lived citizenship has challenges social workers face every day, with focus on the threats to a client’s personal agency and rights within their community. (https://global.oup.com/academic/product/housing-citizenship-andcommunities-for-people-with-serious-mentalillness-9780190265601?cc=ca&lang=en&)

The four aspects of practice outlined: 1) Framework for Support, 2) Social Work Values and Principles, 3) Client Empowerment, and 4) Citizenship are centrally linked to the organizations and systems of governance involved in mental health practice. The social work role in practice and service improvement involves engaging within our organizations and community networks with implementation practices, research, governance and accountability in order to be able to integrate the “bits” of our micro, mezzo, and macro practice.

---

Bill Dare wrote this article for the Eastern OASW Bulletin’s spring 2018 newsletter focused on the theme of mental health.

Please see other articles on the topic by other eastern branch social workers here: https://www.oasw.org/Public/About_OASW/Eastern_Branch.aspx

“No one walks alone, we walk with you,” the Virtual Art in Strathcona Park

Mental Illness Caregiver’s Association (MICA) bridge art, music, care, creativity to building community.

Virtual Art in Strathcona Park
We at MICA are pleased to present the Virtual Art in Strathcona Park – Virtual Art In The Park. This is our first foray into the virtual world—we see it as a work in progress that will continue to evolve, with your feedback and from visitors to our virtual event.

Over the next 20 days (22 August to 10 September) we will present a showcase of arts and crafts, introduce organizations that offer support and services to caregivers and their loved ones living with mental illness, share information about MICA projects, and offer some light-hearted entertainment at our Caregiver Café.

We invite you to take few moments to tour the website, enjoy the arts and crafts, and learn more about MICA. In addition, would you kindly support our celebration by inviting others you know to visit our virtual event – a flyer is attached to do just that!

In closing, be well and be safe, with our thanks ……

See the website here: https://www.micaontario.com/VAIP/

 

Ottawa Community Development Network, a resource to bridge our individual care efforts to client’s everyday lives.

Bill Dare explains – The network is taking on the complexity of the disjointed approaches to individual care and support to bring a “service user” driven foundation to community and neighborhood actions along with finding ways to align organizations and institutions. 

I recently learned more about its efforts to strengthen social and health wellness after discussing with Dianne Urquhart of the Ottawa Social Planning Council  https://www.spcottawa.on.ca/ and attending a community meeting, how:  people are strengthening their own community, neighbourhood and work settings.

Individual practice – care and support can chip at at strengthening individual’s connections in multiple and various forms to their communities.  How to embed, prioritize this approach in everyday practice beyond chipping, is not so easy as we negotiate layers of what is involved with Community Mental Health, Recovery practice but the formal framework  and Community Development guidelines help.

Community Development Framework (CDF) brings together residents, community organizations, and city services in priority neighbourhoods across Ottawa. Together, we:

• Identify local community issues and strengths.
• Decide on the changes the community wants to make and set goals.
• Build on neighbourhood strengths, and develop skills and support to make the changes happen.
  • Some goals require change at a level beyond the influence of the local community (for example traffic calming or access to affordable and nutritious food). An important aspect of the CDF approach is to support the “systems” level (i.e. community agencies and institutions) to address those concerns at a city-wide level.

 

---

Guiding Principles for
Community Development Practice

Coalition of Community Health and Resource Centres
Community Developers Network
February 2018

II. Guiding Principles for Community Development Practice
The importance of clarity regarding guiding principles became increasingly evident as this work
unfolded. The overall connection is the resulting impact on community change. This work is
grounded in over-arching principles of social change and requires foundational supports to provide
the infrastructure capacity for CD practice.

The framework below highlights four core principles that define the work of CD.
 Challenging Systemic Inequity & Power Dynamics & Supporting Empowerment
 Responsive to Community
 Transformational Practice
 Partnership & Collaboration

These principles are strongly inter-related and as such are used in all CD activities. Depending on
the activity, one principle may have a greater focus, but the other principles are still considered
when planning the most appropriate approach.

 The principles guideline for community developers can be found here: https://cdfcdc.ca/wp-content/uploads/2018/12/FINAL-Guiding-Principles-for-Comm-Dev-english-Nov-19.pdf

Learn more at the Community Development website: https://cdfcdc.ca/

“Inside the battle to modernize 1960s-era mental health housing in Ontario” from This Magazine

A thoughtful article by Megan Marrelli from This Magazine https://this.org/. 

It would be easy to simply slam down how things are in domiciliary hostels (Homes for Special Care (HSC) and other municipal residences, now called Residential Support Services).  Instead it brings to light the complexity, including the dynamics of a business that can sometimes impact on the directions residents are able to go to advance in their recovery, participation in community, along with owners/carer’s daily efforts of care along with the role of mental health service providers outside of the residence.

 

On a rainy Thursday in April, I arrive at a yellow brick, split-level house in London, Ont. People are doing word searches at a large dining table. Some help themselves to a container of freshly baked peanut butter cookies, and CBC News is playing on a television in the living room. This house, tucked away in a quiet, tree-lined neighbourhood a few kilometres from London’s gritty city centre, feels almost like a family home. “You’ve come right in time for morning break,” says Sarah Dutsch, the homeowner, as I take off my shoes. This is one of Ontario’s Homes for Special Care: a controversial custodial housing program for people living with severe psychiatric challenges. Sarah and dozens of other Homes for Special Care operators are now in talks with the Ministry of Health and Long-Term Care about the future of mental health housing in Ontario. …

See the Article here: https://this.org/2018/07/24/inside-the-battle-to-modernize-1960s-era-mental-health-housing-ontario/

I hope that local communities and mental health planners bridge the issue to our broader directions in mental health reform, guided by the Recovery Model/Housing First.

The Mental Health Commission’s foundational report on housing and mental illness “Turning the Key” is a useful guide for us. https://www.mentalhealthcom…

 

Ottawa’s Cycle Salvation, social enterprise, individuals building community

The role of social enterprise to support people to enter employment, employment calibrated to a person’s- need, skills is unique in the continuum of Vocational Program development.  In my own practice I’ve found greater potential to actually find the best fit for an individual is through a social enterprise approach.   Maybe it is because of the structure and values in play where, while there always is a boss and a job to do, there are bigger outcomes and expectations involved.   This brief video gives a taste of such an approach.

BTW, they are always looking for bike donations.

See the video here: http://rogerstv.com/media?lid=237&rid=4&gid=283391

Learn more about Causeway’s social enterprise efforts here: http://www.causewayworkcentre.org/social-business/