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Recovery Model: Mental Health Recovery Model Applied to Severely Mentally Ill; JH Rick Massimino MD

"There is no dignity or humanity to be found by allowing someone to live in florid psychosis: this is cruel and unusual punishment"

At a Penn State public forum on its child sexual abuse crisis on 11/30/11, it was said, "It is not sufficient to do only what is legal, one must also do what is moral". Our legal attitude and behavior towards the plight of the most severely mentally ill is not moral.

A new definition of "Recovery", which was published on SAMHSA's Web site on December 22, 2011 now states that recovery is a "process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential." This lofty and lovely sounding goal continues to be a hollow rambling when applied to the realities of those suffering from treatment resistant and/or treatment defiant psychosis. Since most of the funding comes from SAMHSA, most will follow this nearly delusional thinking. Have we completely lost commonsense and consciousness?

An example of the recovery model at work:

http://www.ocregister.com/articles/hoff-341145-mental-son.html

Mentally ill boy turnes 18, public mental health services abandon his care, process of criminalization begins, arrest occurs and release occurs at 4 A.M. (normal policy), boy goes missing! What's Next?

Let's now look at what happens when one applies recovery model concepts to a criminalized population:

 http://www.latimes.com/health/la-me-mental-health-20120415,0,4051609.story

CONCERNING TREATMENT RESISTANT AND TREATMENT DEFIANT PSYCHOSIS:

The only way to reverse recidivism (re-hospitalization and re-incarceration) is by securing treatment adherence (compliance) and best symptom control.Treatment adherence cannot occur without maximal symptom control and vise versa. Understanding the interplay and symbiotic relationship between treatment adherence and maximal symptom control are the fundamental tenets required for creating effective treatment plans i.e. reversing recidivism.   

An entire generation of seriously mentally ill individuals has experienced failed system interventions which have effectively denied them treatment. The evolution of de-institutionalization which was followed by the era of criminalization is now followed by the era of the “recovery model”. Each new ineffective system intervention fails to secure treatment adherence or symptom control. We continue to waste countless lives and exorbitant sums of money due to:  pervasive misunderstanding of how to treat the seriously mentally ill and a lack of courage to apply the right and moral treatment tenets.

The “Recovery Model” has demonstrated little to no value for stabilization and growth of individuals suffering from severe mental illness with or without substance abuse. This website will offer an alternative to the existing ineffective policies and practices mandated by recovery model funding or insurance funding both of whom ignore the most seriously mentally ill.

For an initial analysis on the reasons why the Recovery Model is not suitable for the treatment needs of treatment resistant and treatment defiant psychosis, please click here and read the following

What do the majority of the mentally ill individuals already confined to incarceration, abandoned to homelessness or living lives of desperation inside their families’ homes or community group homes NEED in order to change their circumstances and experience relative wellness? Neither, the Public Health Care System, American Psychiatric Association, nor any Private Provider has yet to reduce the enormity of the problem or offer an effective model of care. The answer can be found in the following “John Henry Model”©. This model of care has been applied successfully for more than two decades and offers stabilization of symptoms, long term adherence to treatment, and growth opportunities consistent with individual skill sets. A short introduction to the “John Henry Model”© is provided below for your consideration. The detailed programming content and treatment plan philosophies are beyond the scope of this introduction. However, one important element of success for this model applies limited and periodic minor restrictions to any right which contributes to illness or endangers the individual for just cause. These rights restrictions are legal in any contractual relationship established prior to initiation of treatment and are only applied for best interest objectives: "Individual Treatment Contract" (c). To read more on the "Individual Treatment Contract" please click here. Any agency or treatment program which follows the party line protecting rights over needs is ineffective, ignores the suffering of the severely mentally ill, and perpetuates the existing problem. To read an analysis of "The Right to Treatment vs The Right to Refuse Treatment", please click here.

John Henry Model (c)
  
Mental Health Comprehensive Integrated Care (Integrated Recovery) is becoming a more frequently used concept for addressing the failed policies of treatment for the chronic and seriously mentally ill with or without co-occurring substance abuse. This population which is either untreated by patient defiance, treatment resistance, or failed access to treatment, consumes the lion’s share of mental health care dollars. Our prisons and state hospitals are full of individual’s dual diagnosed with psychotic disorders and substance abuse histories and these sad lives can be abundantly found among the homeless. 

Any hope of providing effective and sustained treatment will depend on the capacity of a treatment environment to provide the comprehensive integrated services needed to control symptoms, change dysfunctional behavior and thinking, and offer growth opportunities consistent with existing skill sets. This comprehensive array of services or (Applied Integrated Therapies A.I.T.) © are described below and are an integral part of the John Henry Model © of care. Critical to the success of Applied Integrated Therapies is the existence of permanent, suitable, and affordable housing. From this central place of safe and stable housing, these wraparound comprehensive services can be consistently provided and maintained for as long as is necessary.

John Henry Model (c)

Applied Integrated Therapies (A.I.T.) (c) http://appliedintegratedtherapies.com/ http://www.themassiminocompany.com/

"Applied Integrated Therapies for the Seriously and Chronically Mentally Ill with or without co-occurring substance abuse."  Multifaceted integrated treatment strategies whose purpose is to provide stabilization of symptoms, maintenance of realized gains and growth ultimately leading to sustained rehabilitation.  Components of the multifaceted strategies must include:
• Aggressive medication utilization (including Clozapine) with lifelong adherence to treatment
• Individual, Family, and Group Psycho-therapies including but not limited to insight, cognitive and process oriented strategies.
• Intense behavior modification (applied behavior analysis with board certified behavior analyst – BCBA)
• Social skills training
• Continuing enhanced educational and recreational opportunities
• Life-skills teachings (money management, hygiene, time management, prioritization skills, etc.)
• Habit retraining (food, exercise, healthy personal choices etc.) 
• Addiction intervention (overeating, alcohol, tobacco, and drug abuse termination) and abstinence maintenance. 
• Work and structure (discipline) training
• Medical consultants providing continuous collaborative treatment with the mental health team.
• Societal reintegration training (maladaptive behavioral extinction coupled with continual reinforcement of socially appropriate conduct, leading to the creation of independent life-skills and continuous learning and clear thinking mastery.

The John Henry Model (c) "A comprehensive integrated relapse prevention and growth model for outpatient psychiatric residential care."

The John Henry Model designates a unique and comprehensive model of integrated services for outpatient psychiatric care.  In much the same way that we have learned to value a computer's parts, its hardware and software working together for smooth and efficient operation, the John Henry Model similarly merges the hardware (property, structures, personnel) with the software (programming, concepts, routines, schedules and implementation) to create an efficient, effective and economical solution for psychiatric rehabilitation and long-term success.

To implement the John Henry Model is to understand and believe that all of the elements of care required to treat any chronic disabling mental illness must exist in a cooperative, constant, affordable, desirable, competent and accessible form.  One might ask which of the elements of care are more important. Is it constant affordable physician psychiatric care?  Is it decent, permanent single room occupancy housing, Is it oversight, guidance and continuous reinforcement for habit change, compliance and growth?  Is it access to friendship, human purpose and relationship?  Is it the relapse prevention programming and techniques?  The truth is that every element of required care is equally important.  The desired outcome (patient wellness) of any healthcare service devoted to care for the chronically mentally ill will always be limited by the elements of care that are missing, not by the elements of care that are present.  In other words, to offer someone prescribed medication without housing is a failed effort.  To offer someone housing without the opportunity for social engagement and human purpose is likewise a prescription for failure.  The wheel requires all of its spokes.  The building requires all of its support pillars.  The John Henry Model does so with its unique approach to providing comprehensive and integrated services designed to address relapse and encourage patient growth in a setting of outpatient psychiatric residential care.

The full text and description of the John Henry Model expands and defines each essential element of comprehensive care and includes:
• Facilities/physical layout
• Personnel/staff
• Programming content
• Integration philosophy
• Outcome expectations

We hope this brief introduction to the John Henry Model (c) and Applied Integrated Therapies (A.I.T.) (c) has been useful.  Health-care reform which addresses the needs of the seriously mentally ill will require bold innovation, commitment, and a belief that effective treatment strategies are possible. We look forward to your thoughts and ideas.  Please use the email link below.

We would appreciate your comments. 
J.H. Rick Massimino M.D.
 949-413-7315 
E-mail us at:

recoverymodel23@gmail.com