Richard Weingarten

Chronicity Reconsidered: Improving Person-Environment Fit Through a Consumer-Run Service

In the past, the term “chronic” referred to people who had serious mental illness and who typically received long-term care in a state mental hospital. Although this term recently has fallen out of favor, we resurrect the term here, not to revive a demeaning euphemism, but rather to redefine it as the result of a poor person-environment fit between the complex and challenging needs of those with serious psychiatric disorders and a community-based service system that often is ill-equipped to treat them. Previous research indicates that recurrent acute hospitalizations and an inability to establish or maintain tenure in the community may be due to a disconnection from community-based services and supports, social isolation, and demoralization. One promising approach to addressing these issues is that of peer support. To illustrate the potential utility of peer support in improving person-environment fit and decreasing the chronicity of the subsample of people who continue to have difficulty in establishing viable footholds in the community, we describe a peer support-based program, the Welcome Basket, developed, staffed, and managed entirely by mental health consumers. Preliminary analyses that evaluate Welcome Baskets effectiveness are included, and we discuss the implications of these data for future research and program development in this area.

Calculated risk-taking and other recovery processes for my psychiatric disability.

In his new book, Living Outside Mental Illness: Qualitative Studies of Recovery from Schizophrenia, Larry Davidson, PhD, has opened up a very important arena for consumers writing of their recoveries. While consumers have written of recovery as an experience, an attitude and a vision, they have not reported the actual processes of how they got there, according to Professor Davidson (Davidson, 2003). In this article, I would like to begin to bridge that gap Professor Davidson has pointed out by describing three methods and strategies that have been crucial for building a new life for myself in recovery.

The development of peer support in the Netherlands, Brazil, and Israel.

My recent communication and travels related to peer support efforts in The Netherlands, Brazil, and Israel provide a glimpse of the integration of peer support into existing mental health services in these three countries. Country by country, peer support is evolving in unique ways specific to each culture. Based on my communication with peers and colleagues, peer support is fairly well established in The Netherlands, but has not gained as strong a foothold in countries like Brazil and Israel, where governments and mental health authorities have yet to fully embrace the concepts and practice of peer support. Also volunteerism, so essential in the start-up of peer support and self-help groups in the United States in the early 1970s, does not yet exist in Brazil or Israel where there are not as well established nongovernmental (nonprofit) organizations. After speaking with informed advocates of peer support in these three countries, the question, for me, remains whether peer support will take root in countries other than English-speaking countries. Can these voluntary, grass roots, democratic associations have a viable future in countries like the Netherlands, Brazil, and Israel? The hope is that once mental health officials see the success of peer support programs and gain confidence in peer leaders, they will provide the funding and support necessary for peer support programs to grow and thrive.

Moving beyond illness to recovery: the recovery is for everyone Grants Program (RIFE).

The RIFE Grants Program offers funding to individuals in recovery from mental health and substance abuse problems for innovative projects to help them take steps toward achieving their life aspirations. Twenty-one people who received awards participated in an evaluation using the MDS and EPQ with significant increases in items related to empowerment from the beginning to mid study and a decrease in the empowerment factor from mid to end study. Ninety-one percent of participants reported improvements in daily life, 82% in thoughts of self, 80% in belief in capabilities, 60% in social roles, 80% in socializing, and 50% in values.