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❶The ComPeer program matches people with involuntary commitment orders with community volunteers who share similar interests.

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Inform people about the study. In a small state like Vermont where many people have an investment in the mental health system, people like to know what is going on. They tend to be distrustful and unsupportive if they are not fully informed. Articles describing the project were published in the quarterly newspaper of Vermont Psychiatric Survivors a peer-run mental health education and support organization and in other newspapers across the state.

Descriptive posters were posted in key locations around the state including bulletin boards at community mental health centers, drop-in centers, churches, grocery stores, and other public places.

The principal investigator and the coresearcher described the project at a meeting of administrators of community rehabilitation teams, gave them information to distribute, and asked them to talk to people who might be interested in attending the focus groups or the interviews. Staff from Vermont Psychiatric Survivors networked information through their statewide system of support groups.

The principal investigator and the coresearcher made personal calls to key contacts around the state. As a result of this campaign, people in the mental health system statewide learned about and supported the project.

The informational and focus groups were well attended. Many people inquired about the study. Twenty-eight people were interviewed, almost twice as many as had been planned. It is hoped that articles about the study and networking activities had some informational benefits in the greater community that cannot be monitored or measured. Although this campaign was time consuming, it was well worth the effort and would be advisable for future similar projects. The researchers set up and worked with two advisory boards.

In addition to advising the researchers, people on these boards recruited participants, collected data, gave feedback on the study and pilot project design, assisted with implementation of the pilot project, and coordinated efforts to continue project activities after the pilot project was complete.

They offered differing perspectives and were essential to the research process. Both advisory boards presented challenges that took patience, consideration, and consultation to resolve. The Vermont State Department of Mental Health Advisory Board included the state project officer, several state officials, the executive director of Vermont Psychiatric Survivors, and the state coordinator of the mental health recovery education program. At least two of the people on this board were people who have had mental health difficulties and have been users of the mental health system.

Contact with this board was through an initial face-to-face meeting, followed by monthly conference calls. Board members were available for consultation as needed. At the first meeting, the board reviewed the project design and related research, and discussed anticipated problems in recruiting volunteers.

After this face-to-face meeting there were monthly conference calls, members of the committee reviewed documents on an on-going basis, and there was e-mail correspondence to address timely issues. Although much of this input was helpful and facilitated connection with Vermont Legal Aid and the Vermont Agency of Protection and Advocacy, inconsistent participation by members who then challenged decisions made in their absence hampered this mutual work. Key to the success of this committee was the consistent dedication of the state project officer who often cleared the way for progress when others seemed intent on an agenda that was less than supportive.

Several state officials attempted to micromanage the project from time to time. This was frustrating, and the researchers had to use patience and negotiation skills to resolve these issues. The Moving Ahead Project Advisory Board consisted of eight people who were selected by the researchers because they had expertise and experience that was expected to be helpful to the project. The board membership included a person representing the Vermont State Agency of Protection and Advocacy and the director of a regional acute care facility.

The rest of the board members were people who have used mental health services and who have either had current experience with or have histories of involuntary commitment. Meetings were held with this group every other month. The researchers consulted with board members between meetings. This board was primarily validating and supportive, giving suggestions that broadened perspectives and helped in defining the Community Links Project.

Inconsistent attendance and failure to review the interim reports that were used to keep them updated hampered the process. In addition, one person was very contentious, trying and sometimes succeeding to use the meeting to meet her personal needs, and making it difficult to get our agenda done.

It became apparent that it is important to get references for people serving on boards to keep energy from being needlessly wasted. Board members worked together well, using a negotiation and problem-solving process to resolve this difficulty. The purpose of these gatherings was to inform people about the project, to recruit people to serve on the advisory boards and volunteer for the study, and to ask for input on:.

Questions that can be asked of people on involuntary commitment to build a better understanding of what will be helpful to them;.

These meetings were recorded, and the information was used to guide the study and develop the semistructured interview guide. Although it would have been preferable to have separate focus groups and informational meetings, the timeline of the project would have made this difficult. However, given the power of the focus group, it was important to include this strategy, even in a less than perfect context. He goes on to say:. However, participants need not agree with each other or reach any kind of consensus.

Nor is it necessary for people to disagree. The object is to get high-quality data in a social context where people can consider their own views in the context of the views of others. An average of 10 people attended each of these group meetings. Reminder phone calls to key people made it possible for some people who would not otherwise have transportation to attend.

Several mental health workers brought van loads of people. Participants included people on involuntary commitment orders, people who had been on these orders in the past, people who had been in the mental health system but who had not been on orders, clinicians, administrators, and family members.

The researchers began the meetings by describing the project and the need to recruit people to serve on a project advisory board and people who would be willing to be interviewed. This was followed by a rich discussion of the issues. These meetings began to give the researchers perspective on how people feel about involuntary commitment orders and possibilities about the kind of initiative that might be helpful.

Suggestions from the participants were helpful in developing the semi-structured interview guide to use in the interviews. The researchers facilitated these recorded meetings. Specific information and lists of concerns were written on a newsprint pad. In addition the researchers wrote field notes after each meeting. Some of the concerns identified by the various stakeholder groups at these meetings included:.

It was hoped that at least 15 people would be interviewed in this study. However, there were two major issues that the researchers felt might hamper recruitment efforts. Because this tends to be a group of people who have been treated badly in society and in the mental health system, it was assumed that they might have issues that would keep them from volunteering, such as trusting others and trusting the mental health system.

These efforts to recruit people who had orders of involuntary commitment were extraordinarily successful. Because, as previously stated, people who have these orders tend to be distrustful, people on the advisory boards warned the researchers that recruitment would be difficult and that the goal of interviewing 15 people would not be reached.

Actually, 40 people volunteered to be interviewed and 28 people were interviewed. Feedback from people who agreed to be interviewed suggests that the stipend was very important to them and was probably the primary factor that encouraged them to participate. The letters from Vermont Legal Aid and contacts by staff on the Community Rehabilitation Teams also seemed to be key factors in this successful recruitment effort.

Study participants noted that they appreciated the confidential toll-free line and knowing that the people who did the interviews had experience as users of the mental health system. There were 16 men and 12 women in the study, representing proportionally the usual number of people in the state who have these orders.

The population of Vermont is , The group to be interviewed was extremely diverse. Common characteristics are difficult to identify. Some interviewees came from extreme poverty. Others came from backgrounds of wealth and privilege. The advantage that those people who came from wealth and privilege had was that they could hire lawyers so they had more input into their orders and had more choice in care options. A few had less than a high school education, but most had at least graduated from high school.

Some were obviously intellectually gifted. Several had advanced degrees and had been proficient in their fields prior to their involvement with the mental health system. Only one person was currently employed. Another was planning to go back to college. All of the participants had been involved with the mental health system for many years.

The shortest time was two years and the longest more than 25 years. People had a general sense of despair and resignation about their lives. This affected their motivation. In discussing possibilities like recovery education and peer support, although some said these initiatives might be helpful, there was little genuine enthusiasm about anything that was suggested, and no belief that anything positive was going to happen. Each person had a tumultuous and trauma-filled history that often included severe loss.

Although most of this occurred prior to their involvement with the mental health system, some severe trauma and loss occurred within the mental health system and was related to mental health treatment e. With several notable exceptions, the physical health of the interviewees was poor. People were overweight, had various movement disabilities, and had serious chronic illnesses like heart disease and diabetes.

Although they knew they had these conditions, they had little information about anything they could do to help themselves other than medical interventions. Only one person talked about trying to maintain a healthy diet and work on weight loss. The study participants had little insight or knowledge about the possible causes of mental health difficulties and knew little about their own treatment, alternative treatments, and self-help strategies for addressing mental health difficulties.

They were accustomed to having things done to them rather than taking the initiative to help themselves. People also had notably limited systems of connection. Others had only several supportive people in their lives. Some could only name care providers as people in their circle of support. Most had lost connection with family members and did not feel part of any community. All of the people interviewed had a history of being perceived as dangerous, either to themselves, family members, or the community.

The researchers were warned in advance that the interviewees were potentially dangerous. Prior to the interviews, the researchers expressed some anxiety about safety. Consultants from Vermont Protection and Advocacy taught them how to deescalate difficult situations and how to quickly leave a situation that had the potential to be dangerous.

However, the researchers did not experience any situations in which they felt they were in danger. The interviewees were interviewed by either the principal investigator or the coresearcher in one-hour interviews. The researchers worked with the interviewee to arrange a place for the interview that was most comfortable and convenient for the interviewee. Before beginning the interviews, the researchers, using data gathered in the focus group meetings, developed an interview guide.

The interview guide is prepared to ensure that the same basic lines of inquiry are pursued with each person interviewed. It will provide topic or subject areas within which the interviewer is free to explore, probe, and ask questions that will elucidate and illuminate that particular subject. Thus, the interviewer remains free to build a conversation within particular subject areas, to word questions spontaneously, and to establish a conversational style but with the focus on a particular subject that has been predetermined Patton, , p.

Qualitative inquiry, strategically, philosophically, and therefore methodologically, aims to minimize the imposition of predetermined responses when gathering data. It follows that questions should be asked in a truly open-ended fashion so people can respond in their own words Patton, , p. Open-ended questions were designed to avoid predetermined responses.

The researchers noted that after the first few questions, they tended to follow tangents addressed by the interviewee that they felt might lead them to the most helpful information. Why do you like being with them? Why do you think that is? Is that something that you want to change in your life? What sorts of things are you doing and with whom? If so, what has been your experience with Peer Support?

If so, what has been your experience with it? How long were you on? How did you feel about being on it? If so, how was that helpful? A flexible approach was used in the interviews, adapting styles and strategies to best meet the needs of the study participants and to facilitate collection of pertinent data.

Although this guide was far too extensive for most of the one-hour interviews, it provided a helpful structure. In retrospect, it might have been preferable to interview each person several times. In subsequent interviews, participants might have been more trusting, and more open to sharing at a deeper level. In spite of their initial distrust, after the interviewees learned about the interviewer and the focus of the study, they opened up, some slowly, others more quickly, often escalating into an unexpected intensity.

They seemed to relax when they understood that the interviewer was not part of the mental health system, but a person like them who had mental difficulties for many years and had attained a level of recovery.

They were openly surprised that anyone would want to spend time with them, to hear what they had to say, and that anything they had to say might be useful. The time passed quickly. Both researchers reported that they wished for more time and further connection. They left the interviews with mixed feelings, frustration at not being able to spend more time and delve more deeply, and satisfaction that they had ventured into territory that few have been privileged to enter.

In addition, using an informal narrative interview process, the researchers talked to Vermont State Hospital personnel, court officials, community mental health center administrators and care providers, law enforcement officials, and other community members who have experience with or an interest in this issue.

These people were not directly connected to the people that were interviewed, nor did they or anyone know who was interviewed. The researchers recorded information from these interviews with field notes. These interviews were not as helpful as had been anticipated. Those that were most helpful were interviews with people who work directly with individuals who have orders of involuntary commitment, including program administrators and case managers. They talked of their frustration with inadequate funding to provide needed supports and resources that would allow for a recovery-oriented focus.

They supported the possible implementation of a program that would include a system of mentors. Because court personnel did not personally know the people who have involuntary commitment orders, they seemed to be unable to consider other options for people.

Family members, many of whom had little or no contact with the person who has the involuntary commitment order, held views that seemed inflexible. If the study time period had been longer, the researchers would have tried to reach out to more people in the community to see if they could find some with helpful insight.

This chapter provided an in-depth description of the process that was used to gather the data to use in program development, including the methodology, the Institutional Review Board process, project administration, publicity, advisory boards, informational meetings and focus groups, recruitment of respondents, and interviews.

The next chapter will describe the process of analyzing the data from this study. In addition to the literature review, the data from the field notes of the focus groups and informal interviews with stakeholders, along with the hundreds of pages of transcriptions from the interviews with people who have had involuntary commitments, were analyzed to find out what strategies should be included in a program or project that would be helpful and useful to people who have orders of involuntary commitment.

Finding answers to questions posed by Vermont state mental health officials also informed the learning process. It was not the intention of the project to analyze the individual interviewees, but rather to hear them and learn from their experiences.

The researchers began the analysis process by reading and rereading the field notes and transcripts. From the initial readings, the researchers developed a list of 27 domains. These domains were entered into the software program HyperResearch. In addition, one of the researchers had used this program successfully on other projects. To facilitate the analysis process, the researchers developed a list of codes that they felt would most effectively meet the needs of studying the data.

Significant phrases, statements, and sections of each transcript were coded and entered into the software program. This coding was an intensive, extensive, and powerful process. It required on-going revision as the researchers discussed the data and discovered new meaning. The close scrutiny of this potent information was frustrating, draining, and exhilarating: As the data were being analyzed, the researchers continually referred to the literature studied in developing the research proposal, in designing the project, and as the project proceeded.

A sense of hopelessness and disenfranchisement seemed to permeate the data, making it often feel heavy, dark, and incredibly sad. Were it not for the occasional words of wisdom that allowed a glimpse into a different way of knowing, a glimpse that showed the brilliance, the creativity, and the courage of many of these people, the data analysis would have been a dreary task.

After careful consideration, continued review, and discussion of the data, patterns emerged and the codes were collapsed into each other.

The resulting themes were:. Again, the researchers read and reread the transcripts and the theme reports from the Moving Ahead project. They studied the field notes on the focus groups and the informal interviews. They had meetings, phone calls, and strings of e-mails.

They discussed the theme reports and shared various ideas with both of the advisory boards and project consultants. They talked again with some of the people who had orders that were interviewed. Although they continually referred back to the literature, field notes, transcripts, and theme reports, compiling the following summary of each theme helped the researchers clarify possible core elements of the pilot project. Interviewees as a group reported negative experiences with the involuntary commitment process.

Key problems that people had with these orders was lack of understanding of why they have the order, what constitutes a violation of the order, the stigma of being on the order, the lack of choice, feeling like it is a punishment, and the lack of consistency about protocol for getting the order rescinded. They said orders dictated things like where you can live, what you do with your time, and the specifics of your treatment including medications.

They contend that these issues increase frustration and stress levels that make their lives even more difficult and make it more likely that they would have difficult times and continue to need the order. This involuntary commitment order that Dr. He was punishing me. So, why are you on an order of involuntary commitment?

Am I supposed to be a dangerous man? Am I supposed to have done something terribly wrong? Why do you think you have this order of involuntary commitment? Am I supposed to be a danger? Am I supposed to—? No threatening behavior, it says. Did I ever threaten anybody?

And I was never drunk. So, how could it be you have an order of involuntary commitment? I pretty much do what I want as far as the order of involuntary commitment goes. The only part of it that I have to go into is I go in for meetings once every three months, and my injection, once every three weeks.

Aside from that, I pretty much ignore it, because just reading it makes me upset. My opinion is you were in the hospital to get better supposedly. In effect they were using the order as a safety net. In addition, it helped people understand how they can deal with or avoid crisis situations. Certainly, the Vermont Project Chittick et al. People reported that they have difficulty meeting the challenges in their lives, especially those that are unique to their circumstances.

Some of the most common challenges reported by the interviewees included:. They sometimes just make me feel like I should just be in the hospital.

People spoke of feeling controlled by others including their psychiatrist, the courts, specific family members, and the mental health system. Intrusive symptoms over which they felt they had little or no control increased their feelings of impotence. I feel like a baby again. I have to live with them, because they are my guardians. They have all my money. Joking around and socializing is hard.

In the pilot, people were assisted and supported as they worked to meet these challenges in their lives. Identifying these challenges and having them validated in a peer relationship was often a first step Mead, Then a peer or mentor supported them and worked with them to address and relieve these issues, and introduced them to skills that would assist them in addressing life challenges in the future.

Programs that focus on one-on-one mentoring like ComPeer and Peer Bridger see Chapter II are respected for their success in helping people to address their life challenges and move forward with their lives.

The Vermont Project Chittick et al. Some of their methods, which included practice and role modeling, were included in this project. All those who were interviewed reported multiple traumas and losses in their lives. They spoke of loss from:. I had another baby after I left the hospital. Parental custody was removed for all my children and they were adopted. And she kicked me out of the house when I was I was on the streets for a year?

Then I got sent to this Camp for troubled teenagers. Their approach was totally drugs. No therapy, no nothing. Before I left there, I tried suicide just a couple times, but nothing real serious. When I was up there at … Camp, I went over to … and took a bunch of wooden chairs and paper towels and all that stuff and put it in a circle and tried to kill myself.

Set them all on fire. The only thing that saved me is one of the handymen there saw the smoke, and pulled me out of it. So I tried to get a hold of my wife. Clearly the pilot program needed to validate the loss and trauma people have experienced, give them opportunities to talk about it, and discuss the role of trauma in their mental health difficulties.

People involved in the project as mentors or peers needed to receive instruction in trauma-informed methods and use them to guide their relationships with people who have orders of involuntary commitment Mead, A few people found diagnosis to be minimally helpful. Others did not and often found it to be harmful.

Many people did not understand what the diagnosis meant. It was clear from these responses that the pilot project, in order to be most inclusive and to be respectful of all views, needed to avoid a diagnosis basis. This meant that, in order to take part in this program, a person did not have to be specifically diagnosed with an illness like schizophrenia or bipolar disorder, or accept that they have a mental illness, but rather it was a program for people who have mental health difficulties, have an order of involuntary commitment, and wanted to work toward their recovery and independence.

However, activities in the pilot helped people to understand any diagnosis they have been given and to make decisions regarding what role they want that diagnosis to play in their recovery and their life.

The program was clearly and intentionally complementary to medical treatment and not designed to take the place of medical treatment. They hardly knew enough about recovery even to dream of it. They seemed almost afraid to dream of any positive change in their lives. In responding to questions regarding their hopes and dreams, they said they were told what their hopes and dreams should be, and were not supported in having hopes and dreams of their own.

Most said they had given up on or forgotten their dreams and had little or no hope. With further interviewing, they shared hopes and dreams that included things like independence and recovering parts of their previous lives that they had lost, like their home life, custody of their children, and certain relationships. They talked about helping others, going back to school, having a family, making enough money to live comfortably, pursuing a career, regaining their health, and doing normal things in the community like shopping and going to the movies.

The literature clearly shows that people who live with even the most severe mental health difficulties can get well, stay well, and successfully do the things they want to do with their lives Desisto et al. People shared a multitude of strengths, abilities, and interests. However, many of them noted that they no longer have opportunities to use their strengths and do the things they can and like to do. It seemed obvious that creating opportunities for people to pursue their interests and strengths might renew their passion for life, enhance their quality of life, and help them to feel better Rapp, Some people found it hard to identify interests and strengths.

When asked what their strengths and interests are they responded with statements like the following quote from a study participant: It could also lead them to discover new interests as well as explore things they used to enjoy and try them again Copeland, Among the interviewees, there was a general sense of despair around the conditions of their lives.

They made little connection between their life circumstances and the various life traumas they had experienced or specific actions they had taken. This clearly affected their self-perception. The pilot project included activities that help people develop self-esteem, learn how to self-advocate, and practice self-advocacy Copeland, As they developed these skills and felt better about themselves, they felt more ambitious and motivated and began to take on recovery-related tasks.

The common thread that ran through much of the data was that people wanted to feel close to others, to have relationships, and to feel connected to their natural community. Most also thought that they would benefit from peer support and recovery education in their efforts to reach that goal. People want connection with others and a strong sense of community outside of the mental health system.

In analyzing the data, it became clear that in all kinds of relationships peer, family, intimate, mental health system, and community , the qualities that people felt would be most helpful in others included many that are the same as for peer support Mead, People said their relationships with family were not good and that they want them to be good.

They craved strong connection with their own children, many of whom had been taken from them long ago. They spoke of abusive spouses and parents, but did not mention any possible connections between this abuse and their mental health difficulties. Almost all of the interviewees spoke of their lack of intimate relationships and their wish for intimacy in their lives. And many emphasized a strong desire to be in close connection with their community.

Some of the words and phrases that they used to define close relationships that guided pilot project relationships include: Although it was expected that people would want more connection with their peers in the mental health system, that was not a finding of this study. Rather people said they want to know how to sustain close relationships with the people in their lives, meet and become friends with people outside of the mental health system, and be involved in their community.

Therefore the pilot program helped people develop interpersonal skills, create opportunities to meet potential friends, and feel more closely connected to their community.

People shared extensive lists of things they know they can do to stay as well as possible and that help when they are having a hard time. People said it would help them to recover and get off the involuntary commitment order to: Other important ideas included:.

These lists are similar to the lists that people put forth when they develop the Wellness Tools section of a Wellness Recovery Action Plan Copeland, b.

In the pilot project, people had an opportunity to develop long lists of tools and develop plans that would guide them in using these tools. People eschewed the following values, which would not be a part of the pilot project, were not helpful, and were often harmful: People in this group seemed to have little knowledge about their medications.

In several cases people reported that they willfully stopped taking their medications to get back into the hospital, as their living circumstances had become intolerable, such as living on the street in winter, being forced to share living space with people who treat them badly, or not having enough money to buy food. People who facilitated the pilot project did not have the expertise to advise people about medications the project did not have enough funds to hire such a person.

However, a part of recovery education and the peer relationship, when it seemed necessary and appropriate, was to learn together about the medications and medication management, and help people find the information they need to make medication decisions. People who took part in this program as mentors were told that they could not and must not advise people about taking or not taking medications, but could suggest the person talk with their doctor when these issues arise.

They were advised of the liability issues related to advocating that a person stop taking their medications. This was an interesting finding given that the Vermont State Department of Mental Health through Vermont Psychiatric Survivors supports an exemplary peer-run program that sets up peer support groups across the state and offers on-going, free recovery education and Wellness Recovery Action Planning seminars that are open to anyone.

It seems that information on the availability of these initiatives is not reaching people who have involuntary commitments, or they are not willing to participate in these activities. Several people said that they thought these programs would be useful to them. By incorporating these approaches in the pilot, this project had the potential for demonstrating how these initiatives would work for people who have or have had involuntary commitments.

The interviews show that these initiatives needed to be modified to best meet the needs of people in this group, be easily accessible, and voluntary. As an end goal, the people who were interviewed felt that becoming fully integrated into the community was more important than peer support. Peer support might allow people to practice skills they needed to become more fully integrated into their community.

In developing the pilot project, it was useful to look at the common experiences that the interviewees shared. Each person had, at some time, been hospitalized at the Vermont State Hospital. Several were currently patients in that facility. The following quotes from people who were interviewed in the study describe what they found to be helpful about the hospital experience.

Being around people, caretakers, workers, who care about you. Good change of pace from sitting there alone, feeling depressed, feeling rather desperate about a situation. The pilot project did what it could to emulate the positive aspects of the hospital experience that were noted by these study participants.

Although several people reported there was plenty to do, things like going to the canteen, woodworking, groups, crafts, and spending time in the gym, others complained that there were long periods of time when there was nothing to do, especially on the weekends.

Weekends are really, really slow. I listen to my walkman, watch a little TV, exercise. The pilot project introduced people to activities that they can engage in either alone or with others when they are living in the community Copeland, Usually, it will take me about a year to recover from the hospitalization.

Cooped up like this is horrible. The air is stagnant. I think the hospitalization, in large part, represents the sadism of the human character. I think the staff there was really horrible. At least one in particular was very disrespectful, and sexually inappropriate. When people who were very sick would do strange things he would laugh.

The emphasis was on disciplining people and not really on helping them. I was also being treated lousy. People complained about a lack of transitioning from the hospital to the community. For instance, one person said:. They just sent you to court and if you got out, you got out.

They should have had a psychologist there working with you, talking to you about adjusting to your new environment, which is a shocker when you get out. How to adjust and giving you ideas and really laying the groundwork for you. I had to adjust on my own. It was a highly sophisticated transitioning program that could easily be replicated by the hospital at this time. As happened in the Vermont project, the pilot project included mentors who could go into the hospital as people were preparing to leave and work with them on developing plans for how they could manage when they got out.

This person could also be an advocate and could provide education, support, and companionship while introducing the person to a variety of activities and community resources. Study participants were not accustomed to being asked for recommendations. However, when they realized that their ideas would be heard and validated, they were willing to talk about their ideas.

Most of these ideas are incorporated in the other theme summaries. However, several people suggested the option of trained peer mentors, people who would listen and provide a bridge back into the community. These would be people who could be trusted and who would help people make choices and who might serve as a role model. They could attend events and share activities. These nonjudgmental, caring people would be like natural friends and would have nothing to do with mental illness.

The data analysis process was further enhanced by responding to the questions posed by the Vermont State Department of Mental Health in their request for proposals. How are people who have involuntary commitments currently interacting with professional and peer organizations and the community?

Very few people had a sense of, or connection to, their larger community. Many people felt isolated due to their lack of transportation, limits on personal freedom, stigma, and the loss of old friends.

It was also not uncommon for people to identify their residential program or even the state hospital as their community. When people had internalized the message that they are different from others they often felt shame just walking around in the community, felt that people judged them unfairly, or were worried that they might have an embarrassing incident while in the community.

Many people identified recovery as having friends outside the mental health field. Because of this lack of connection, mental health workers were often cited as either sole supporters or as controlling parental figures. When people had had good experiences with mental health professionals, the qualities they cited as helpful were: Many people were anxious to break off their connection with mental health services.

They spoke about the over-controlling nature of the relationships, the lack of collaboration around medications, and the perceived use of orders of involuntary commitment as punishment.

It was also quite clear that some of the incidents resulting in hospitalization were perceived differently by mental health workers and the recipient. What are the treatment and support needs of people who have orders of involuntary commitment that are not being provided by the current professional and peer support systems?

Participants had many treatment and support needs that went beyond the scope of their current services or connections with peer support. For example, many people felt that they had little connection with the larger community, that friends were hard to make, and there were few places where people could get together.

Although some people used the local clubhouse, most did not find it particularly stimulating; and no one identified it as a place to build connections.

Mentoring or one -to-one peer support came up frequently. Interestingly, many people also wanted to be on the other end of the helping relationship. When asked about becoming peer mentors themselves, many people thought that would be a great idea Chittick et al. While some people were already working out, many others felt bogged down by too much medication, weight problems, or limited physical ability.

They also felt that there were not sufficient resources or programs that could address their individual needs. Most people said they were not interested in going to groups; they had been forced to go to groups in treatment settings and felt certain this would be the same.

Specific WRAP programs tailored to the individual might allow people to do it in their own way and to avoid groups. Finally, many people felt frustrated by the lack of information about their medications and the lack of collaboration on medication related issues. About one third of the people interviewed felt that treatment had been very helpful, and two thirds felt limited and trapped by the system. What factors have contributed to instances in which these individuals have accepted or sought out support?

Most of the people who were interviewed are solitary. Few have sought out or accepted support when it was offered; they only sought out support when they were forced to by the system and when they were placed in circumstances, like the state hospital, where there is on-going contact with others.

A few attended groups and programs that were mandated or strongly suggested through the mental health center. Several people reported positive involvement with support-related programs in specific locations. Almost all of the interviewees reported a yearning for close connection with others.

What factors have contributed to instances in which individuals who had been receiving a high level of involuntary treatment were able to no longer require involuntary treatment? In talking to people who have had involuntary treatment in the past, the key factors that seemed to make it possible for them to move on included a change in their perception of what they can do to help themselves a more positive outlook , mutual support, use of self-help techniques and strategies, and adequate housing and financial resources.

What external and internal pressures legal, community, financial, and ethical do mental health providers face when serving or not serving these people? In talking with Community Rehabilitation Team directors and other mental health providers, it is clear that they have a dilemma. They need to be concerned with both the needs and rights of the person they are serving, and the protection of the community.

Although they are ethically committed to the least invasive and restrictive options for everyone, their decision-making is often driven by concerns of liability and responsibility to the larger community. Financial concerns limit possibilities. Cost is always an issue. The focus often needs to be on giving the person the best possible service for as little money as possible. With more adequate financial resources, mentoring, educational, and peer support programs could be implemented—programs that might better meet the needs of people who have orders of involuntary commitment.

However, funding for these kinds of initiatives continues to be cut. Anything that can be done to reduce the need for involuntary treatment of any kind will relieve the pressure on mental health providers, allowing them to provide higher quality service to all who need it Copeland, To what extent have recovery education and peer support been accessible and helpful in supporting these individuals?

People in the study reported little access to recovery education and peer support initiatives. Almost all of them knew nothing about these kinds of programs. When they understood what they were, they thought these programs sounded like a good idea. Anyone on an involuntary commitment order needs to be informed about recovery education and peer support opportunities and how they can access these services.

The availability of these services needs to be expanded. In addition, the programs need to be presented in diverse formats and venues to make them most available to people with varying needs Copeland, c. This means that they could be offered one-to-one, in small groups, or in larger groups settings. Materials could be available to be read, on tape, or described by someone else. Programs and materials could be modified to meet individual needs. A key place to offer recovery education and peer support is in the state hospital and in community treatment centers.

A next step might be making them more readily available in the community. Because people on involuntary commitment orders often have issues with trust and relating to others, it is suggested that the first experience with mental health recovery initiatives and peer support be in a one-to-one situation with a peer mentor.

What new and innovative approaches for working with individuals with severe and persistent mental illness exist that could be incorporated into recovery and peer support approaches to help reduce the need for involuntary treatment? Several innovative programs were identified as helpful in relation to the development of the pilot project. Further information on these programs is included in Chapter II. From this assessment and the literature review, the core elements of the pilot project were developed.

This chapter describes the development and implementation of the pilot project which resulted from the analysis of the data of the Moving Ahead Project and the development of Community Links: Pathways to Reconnection and Recovery Implementation Manual,. The researchers and the advisory boards worked collaboratively to develop the Community Links program.

Some of the interviewees also provided input into the pilot project design. Project development was guided by the core elements, which were discovered through the data analysis of the Moving Ahead Project including the literature review, interviews with people who have or have had orders of involuntary commitment, and interviews with other stakeholders.

These analyses revealed core elements that the principal investigator felt would be critical to the success of the pilot project. The CEO was encouraging me to take a close look. Year end activities got in the way. We were in the midst of a string of posts on what we look for in our investments when we went radio silent. Fred Wilson — January 10, Geography Each month we see something like thirty to fifty new investment opportunities that generally fit our investment strategy. They come from all over the place.

Fred Wilson — November 28, Deal Size Brad and I have been doing early stage investing since the late 80s me and early 90s Brad.

So when we sat down to build the Fred Wilson — October 24, Fred Wilson — October 15, Traction This is my second post on "other things we look for". I hesitated to use the title Traction because its certainly one of the most overused words in the venture capital vernacular. But it is also the "shorthand" peope use to talk about how much uptake a given project has gotten Fred Wilson — September 30, Most of our investment approach is built on top of our foundation as early stage investors.

But what does early stage investing really mean? Fred Wilson — September 19, Those posts are archived here. As Brad said in his introduction to those posts: A year ago when we first re-launched our web site as a blog, we did so because we felt that the environment was Fred Wilson — September 6, Union Square Ventures Often in our business you work on things for months and even years without being able to talk about them outside your immediate group of colleagues and family members.

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ACKNOWLEDGEMENT. This dissertation would not have been possible without the guidance and the help of several individuals who in one way or another contributed and extended their valuable assistance in the preparation and completion of this study. Thesis or Dissertation. S. Joseph Levine, Ph.D. Michigan State University East Lansing, Michigan USA ([email protected])) Become a Fan. Introduction. This guide has been created to assist my graduate students in thinking through the many aspects of crafting, implementing and defending a thesis or dissertation.

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