Yale Psychiatry Grand Rounds: October 6, 2023

October 06, 2023

Information

"Citizenship and Community Inclusion: Why it Matters and What We've Learned From Around the World"

Speakers: Michael Rowe, PhD; Gillian MacMillan; Annie Harper, PhD; Francisco Orosa; Fiona Wong; Billy Bromage, MSW; Bridgett Williamson; Jean-Francois Pelletier, PhD; Erika Carr, PhD; Allison Ponce, PhD

ID10828

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00:00So good morning, everyone.
00:02Just a second. My name is Annie Harper.
00:06I'm the now the director of the
00:08Citizenship Community Collaborative,
00:09which we call CCC since
00:11Michael retired in December.
00:12Big shoes to step into.
00:14I'm also direct director of the
00:16financial health work we do here.
00:18And firstly, I want to stay on
00:19behalf of the director of Perch,
00:20Doctor Sherrell Bellamy,
00:21who's with us today,
00:22and the Perch leadership,
00:23faculty, staff and collaborators.
00:24We so appreciate you all being
00:26here today to honor the work of
00:28Michael and all the scholars that
00:29have been influenced by his work on
00:31citizenship and community inclusion.
00:32It's really an amazing experience
00:34to be part of something that's
00:36making such a difference around
00:37the country and around the world.
00:39So my personal involvement in this
00:41work started when I met Michael,
00:43maybe 10 years ago or so,
00:45introduced to him by our own
00:47dear colleague and person I
00:49call Master of Connections.
00:50Kyle Peterson.
00:51And Michael saw the role that I,
00:53as a cultural anthropologist who
00:55studies money and financial systems,
00:56might play a mental health
00:58research and practice.
00:59I have no knowledge of health or
01:01healthcare and really still don't.
01:03But Michael understood that if
01:04we take the social or structural
01:06determinants of health seriously,
01:08we need to be working across
01:10boundaries to really understand and
01:11address the determinants that have
01:13such a profound impact on the mental
01:15health and wellbeing of so many.
01:16Michael recognized the value of my
01:18understanding of the ways that our
01:20economic and financial systems work.
01:21All very often don't work for people,
01:24particularly people who are
01:25poor and have mental illness.
01:27And this,
01:27for me is the heart of the
01:29citizenship approach,
01:30recognizing that very often the problems
01:32that we grapple with around mental illness,
01:34and thus the solutions,
01:36lay far outside our biology,
01:38our bodies,
01:38our brains,
01:39and indeed the clinics where we
01:41where we usually treat the problems.
01:43So as far as my financial health
01:45is concerned,
01:45with the support of Michael and the CCC team,
01:47we've developed a financial health
01:49program that explores what we
01:50need to be doing differently.
01:51And by we,
01:52I don't mean just us who work
01:53in mental health,
01:54but we as a society and specifically
01:56the financial services industry,
01:58what that needs to be doing
02:00differently to make sure that
02:01everyone can be financially healthy.
02:03And this includes people who may
02:05sometimes need help managing their money.
02:06And actually that's all of
02:08us probably at some point.
02:09This is not just a mental health problem,
02:11you know, mental health, For example.
02:13In financial health work,
02:14we're exploring ways to make sure
02:15that people with mental illness
02:17who've been incarcerated aren't facing
02:18financial problems that get in the
02:19way of their recovery and their reentry.
02:21We're exploring what we can do
02:22to ensure that people who do need
02:24someone to help them manage their
02:25money have the options they need
02:27to ensure they can do that with
02:29the maximum dignity and autonomy.
02:31One of the amazing things about the
02:33citizenship approach and working in
02:35this place is that it insists that
02:36we don't get stuck in our own silos.
02:38So my focus is finances,
02:40but that's never all I'm working on.
02:42I'm constantly engaging with colleagues
02:43who address other parts of life,
02:45which are all related.
02:47A few of those are listed,
02:48if you go to the next slide
02:54on a few of them are listed here,
02:56from learning collaborative training
02:58providers around the state of
03:00Connecticut all the way to the
03:01to the music theatre and magic,
03:02the work that we've done
03:04and they're still doing.
03:05The Citizens Project listed here is
03:07the most longstanding program of the
03:08citizenship work and the foundation of
03:10almost everything that's come afterwards.
03:12My colleague at Perch, Betty Benedict,
03:14has led that work for years,
03:15and we'll hear later from Bridget Williamson,
03:17also from Perch, who's currently
03:19director of the Citizens Project.
03:21Bridget and another colleague from Perch,
03:22Billy Bromage,
03:23will talk about the incredible work.
03:24They do engage in community doing,
03:26community organizing,
03:27and really addressing through
03:29advocacy the policy level,
03:30structural determinants of health.
03:32And we'll hear from other colleagues at CMHC
03:35who've been influenced by Michael's work,
03:36Erica Carr and Allison Ponce.
03:39Then we'll hear from people across the globe.
03:40Jean Francois Paletier from the
03:43University Of Montreal in Canada.
03:45I'm going to mess up the name,
03:46but I'll do my best.
03:47Francisco Aroa Arosa from the
03:49University of Barcelona in Spain,
03:51Fiona Wong from the Richmond
03:52Fellowship in Hong Kong,
03:54and Gillian McIntyre from the University
03:55of Strathclyde in in Scotland.
03:57This is really just the beginning of
03:59the citizenship work and Michael's
04:01work has laid this foundation for us.
04:03And we will hear a bit more
04:05from Michael at the end.
04:06So I'll pass it on now to Fran.
04:07And I hope,
04:08Fran,
04:08you have time to do this before you
04:10have to leave to pick up your children.
04:12Thank
04:12you, Annie. Well, so in my presentation,
04:16we'll have five parts.
04:17It's going to be short,
04:18but I'm going to talk a little bit
04:20about discrimination history, measure,
04:21training and finally citizenship.
04:24So next, I guess. Yeah.
04:29So when I met Michael and and I
04:32listened to to his work and and so
04:35Larry Davidson and everything that had
04:37to do with recovery and relationship.
04:39I wondered what makes the people you
04:41can see on the left to the people that
04:44you can see on the right that supposedly
04:47also had a mental health problems
04:50during their lives and I said okay,
04:52it's a question of power.
04:55So why I need to to tell a history
04:58to myself about how this connects to
05:01with the history of mental health,
05:03mental health care.
05:04So I did this graph that I used to
05:09explain recovery and citizenship
05:11to to people here in Spain.
05:13And basically I understood that we
05:16started treating people from our
05:19custodial system and then we we
05:21changed to trying to heal people,
05:23trying to rehabilitate, rehabilitate people.
05:25And then the recovery model
05:29appeared. And then how does that connect
05:32with citizenship, which is next,
05:35not next, not an alternative to recovery,
05:40with something that in my opinion at
05:43least gives context and a political
05:46background to the recovery model.
05:48Yeah, it's here's a paper by Larry Davidson
05:52and Michael Rowe that is recovering this
05:54relationship that can give you some tips.
05:57So the first thing that I
05:59wrote and that was the plan.
06:02So what I will be doing when I go to funding,
06:04what I will be doing the next year with
06:06Michael Rowe, and this is the paper.
06:11So why I I planned 33 phases.
06:15In each of them there was a preparation
06:18and involvement and an evaluation phase.
06:20I started by no, don't go back, please.
06:25Yeah, So I started searching for
06:27well established models and I
06:29found recovery and citizenship and
06:31I I found internationalized and
06:36I did focus groups and interviews
06:39with stakeholders in Spain.
06:41We did an its assessment and we
06:43elaborated some measurement instruments
06:44designed and support and professional
06:46training activities and measure
06:48the impact of these activities.
06:49And now we are currently in the third
06:53phase in in which I am trying to
06:58give some inputs to the citizenship
07:00model at a policy making level.
07:02I was recently at the Parliament of Catalonia
07:05and I'm in some advisory bodies next.
07:10This is the measure we did is a Beliefs
07:14and Attitude Mental Health Scale,
07:15which measures some beliefs
07:17and attitudes that are related
07:18with recovery and seditionship,
07:20and how mental health professionals
07:22connect with these attitudes and beliefs.
07:24It's validated and you can download
07:26it for free in this journal,
07:29and it was used to measure the
07:31impact of our activities with
07:32mental health professionals. Next,
07:37the dimensions.
07:38You can see in the screen the
07:40dimensions of this measure system
07:43criticism, justifying beliefs,
07:45freedom versus coercion,
07:47empowerment versus parallelism,
07:49and next tolerance versus discrimination.
07:54We also did a systematic review of
07:57meta analysis of recovery educational
07:59interventions to see what people
08:02had done before us and we saw
08:04that there were positive results
08:06for for beliefs and attitudes.
08:08So recovery oriented training
08:11activities during the 90s and the
08:142000s had a an impact on over the
08:18release and attitudes of professionals,
08:19but it was not so clear for recovery
08:21based practice as you can see in the
08:23graph in this final plot on the right next.
08:28Thanks to this review,
08:30we were able to design and implement
08:33continuing education activities for
08:36mental health professionals and also
08:39training for training for the trainers
08:41of peer support that is now currently
08:45being carried out in Catalonia.
08:47So we are starting to carry to train our
08:50first peer support workers here in Catalonia.
08:53Next and this is the results of
08:58the evaluations of this recovery
09:01oriented recovery and rights based
09:05oriented activities with a class of
09:07randomized weightless control trial.
09:09And we saw that there was,
09:11there were positive results
09:13especially for coercion.
09:14So our training activities decreased
09:18the beliefs that coercion or coercive
09:21practices are good in in mental health.
09:25This was done with more than 500 mental
09:29health professionals and next and now we
09:32are starting to design and implement.
09:35Also this is now 2019,
09:39some training activities that
09:41are purely based on citizenship.
09:43On the citizenship model,
09:44this is one thing that we use.
09:46We use this thing,
09:47this table that you can find on the right.
09:50So we make students participants,
09:54analyze the places they work or they do
09:59internships or whatever in terms of rights,
10:02responsibility in terms of the five hours,
10:03rights,
10:04responsibilities, roles,
10:05resources and relationships.
10:06Elements to highlight part of
10:08the program where they work,
10:09that they believe they already deal
10:11with this dimension of citizenship.
10:14And all the other elements that
10:15should be reflected on part of the
10:17program that we believe it could be
10:19modified to deal with the dimension
10:21of the citizenship more deeply.
10:23Next and now we are going to carry out
10:29another randomized trial of awareness
10:30interventions for mental health
10:32professionals based on the solution model.
10:34This is what we are currently doing.
10:35This paper is from this year
10:38in this back back please.
10:43So to finish,
10:46to wrap up in this, in this the,
10:50the message is that instead of
10:52treating aspects of the citizenship
10:53as determinants of mental health,
10:55that is already the case,
10:56but without a clear impact on
10:58changes in the care model.
10:59Our can you go back,
11:00please?
11:03Our proposal is to treat citizenship
11:04as the main outcome of any mental
11:06health intervention and treat
11:07psychopathology as one among
11:08many others of its determinants.
11:10Thank you.
11:11And I am going to turn it over to John Hasso.
11:16Thank you.
11:19Thank you, friend. Thank you, Michael.
11:22Nice to meet you all today.
11:25My name is Jean Francois Peltier.
11:27You can tell it's a French name.
11:29I live in Montreal, Canada.
11:31I'm an assistant clinical professor at Yale,
11:34and I'm also a clinical researcher
11:38at the Integrated Health and Social
11:41Services Center in West Montage.
11:43This is on the South Shore Of Montreal.
11:47You see here the the colored sections of
11:52this huge agency in the province of Quebec.
11:56We have 16 regional authorities and this
12:00is one of them to cover the territory.
12:03And we have about 500,000 inhabitants
12:07and more than 10,000 employees.
12:10So it's a big area and now
12:13I'm a clinical researcher,
12:15I'm still affiliated with the university,
12:18but more more more importantly,
12:21I'm really into the system as a clinical
12:25researcher and I'm also been affiliated
12:28to purge for more than 5015 years now.
12:31And my background is in
12:33the political science,
12:34so citizenship and political for
12:37political sciences scientists of
12:39course it's it makes a lot of sense.
12:41And what I want to present to you
12:44Michael today is that I think we,
12:46we made the great,
12:48great progress into that very public
12:51mental health system and and addiction.
12:54So I'm a peer,
12:55I'm a peer support worker too.
12:57And the next slide please.
13:01So this is the structure of the
13:05Sismo integrated.
13:06It's a service in Monte Regi West
13:09so that makes Sismo Okay that
13:11this greater big organization.
13:14We have mental health on one
13:17side and addiction on the other
13:19side and with about
13:23500 full time equivalent employees
13:27for mental health and addiction
13:30and I'm for the both mental health
13:32and addiction. Next slide please.
13:36So we are. I'm a peer support worker.
13:40For support workers,
13:41our person with first hand lived
13:43experience of mental health or addiction
13:45problems and who are further along
13:48in their own recovery journey and
13:50we can provide supportive services.
13:52And what we did that this agency is
13:54that all peer support workers will be
13:57using the citizenship measure combined
13:59to the recovery assessment scale.
14:01And this is really a first,
14:03it's a official clinical tool.
14:06Okay. Next slide please.
14:11And we started to the development of
14:14the citizenship measurement several
14:16years ago and we translated it in
14:19French into French, French Quebecois.
14:21As you know, Canada is a bilingual country,
14:25but there is no such things as
14:28a one Canadian health system.
14:30We have 10 provinces,
14:32so there are 10 provincial health
14:34systems in the province of Quebec,
14:37it's in French and also we have in Montreal.
14:40It's also we have an English
14:42speaking community,
14:43but we translated with Michael
14:46the citizenship measurement into
14:48French and it has been evaluated,
14:51it's validated.
14:52So we have a combination of
14:54the citizenship measurement,
14:55the recovery assessment scale.
14:57Both have have been validated in French
15:00and in English and you see there the,
15:02the,
15:02the current backs here,
15:03Next slide please.
15:07So when we did this validation,
15:09we combined the two tools,
15:10the Ras and the CM and that makes a 47 item
15:17measurement of personal civic recovery.
15:19That's the name we chose and you see
15:22below for clinicians with us today,
15:24you will recognize classic
15:26clinical tools that are used in
15:29clinical settings by clinicians.
15:31Those tools were designed
15:33by clinicians and academics.
15:35That's fine.
15:36But the recovery assessment scale
15:38and the citizenship measurement were
15:40developed too with service users and
15:43by service users for service users.
15:46And the next slide please.
15:49We've been able with the the
15:52department of the medical archives,
15:55we negotiated to have this tool
15:58really to be used on a regular basis.
16:03This is more and we have a
16:07received two days ago the number,
16:09the number of that tool is
16:14606522. That's the number of the beast.
16:16OK, so it's really important we
16:19have a first official clinical
16:22tool in the public system for peer
16:25support workers to have something
16:26that is really reserved for them.
16:29Other conditions have their
16:31own reserved act and tools.
16:34And now we will be using this combination
16:36of the citizenship measurement with
16:38recovery assessment scale to guide
16:40and define the peer support workers,
16:42individual and group interventions.
16:44And there's a typo here.
16:46It's really to write,
16:48to write evolutionary notes to
16:50the medical record of our service
16:52user that will be supported
16:54by the peer support workers.
16:57So Michael,
16:58I think you will be happy to see
17:01the big opportunity we have here.
17:04This opens the way to multiple
17:07research projects,
17:08including longitudinal studies and
17:10in combination with other sources of
17:14data provided by the public system.
17:16So we for example,
17:18we might we might want to come
17:20back in 1520 years from now.
17:23Do the service users that were
17:26supported by peer support workers who
17:28use the combination of the citizenship
17:31measurement and recovery assessment scale,
17:33can we see some changes over time,
17:36not just at six months or 12
17:39months but maybe up to 20 years.
17:41Do we see different service use
17:44medication and things like that And
17:47and those data will be provided by
17:50the public system not by the the,
17:53the, the,
17:53the add on from the academic research.
17:56And so it will become really
17:59mandatory for peer support workers
18:01to use this new clinical tools,
18:04clinical tool.
18:04And to our knowledge,
18:06I think it's the first certainly in Canada,
18:09maybe North America that we do
18:11have with the public system,
18:13an official clinical tool reserved
18:15for peer support workers.
18:17And that tool is a combination of
18:20the citizenship measurement and
18:22the recovery assessment scale.
18:24That's it for me. Thank you.
18:25Now I passed the mic to my colleague
18:28and friend Gillian for Scotland.
18:33Thank you JF. Hi everyone,
18:35and my name is Jillian McIntyre and
18:38I'm here to talk to you about the
18:41citizenship work that has been taking
18:44place in Scotland over the last few years.
18:48In our work with Michael and Perch
18:50began in 2014 and at that point
18:53we were lucky enough to receive
18:55funding from Horizon Europe.
18:57That was at the point in time when
19:00Scotland was technically still in Europe
19:02to fund an exchange between researchers,
19:04policymakers, practitioners and
19:06people with left experience.
19:09And that facilitated a number
19:12of exchange visits between
19:14Scotland and colleagues at Yale.
19:17And this allowed us to carry
19:18out a whole range of activities,
19:20including developing research projects,
19:23joint supervision of PhD studentships,
19:26hosting conferences together
19:28and producing joint papers.
19:31In next slide please gratsy.
19:34I want to focus though today on the
19:37production of the Scottish Citizenship
19:39model and measure and because this
19:41is a piece of work that we are
19:44particularly proud of in Scotland,
19:47we were we received additional
19:49funding to carry out this work
19:51from Turning Point Scotland,
19:52Scottish Recovery Network and the
19:54Health and Social Care Alliance.
19:57And so as you can see from the slide,
19:59this work has been fully written up and
20:01published and with a number of papers.
20:03And this one he does from health
20:05and social care in the community and
20:07and this slides he outlines that the
20:10key stages that we went through to
20:12replicate exactly the work that had
20:15been carried out and perched to develop the.
20:17The citizenship and model and measure.
20:21So we carried out a number of
20:23focus groups with those who had
20:25experienced life disruptions to ask
20:26what citizenship meant to them,
20:28and we then analyzed that data
20:30to generate over 100 statements
20:33on citizenship and then asked
20:35participants to manually sort these
20:38using a process of concept mapping.
20:41We then went on to carry out
20:43Multidimensional scaling and cluster
20:45analysis and that helped us to produce
20:48a model of citizenship for Scotland.
20:50And if we move to the next slide
20:53Scratchy we can see here this is
20:56the representation diagrammatically
20:58of the Scottish citizenship model.
21:01And and if we move straight to the
21:04the next slide we can see that the
21:07the Scottish model of citizenship
21:09followed very closely and and and has
21:11a lot of similarities with the the
21:145R's and and the the United States
21:16and it has five core clusters which
21:20are around building relationships
21:22acceptance and autonomy access to
21:24services and support shared values
21:27and social roles and civic rights
21:30and responsibilities.
21:31And I think what was really important
21:33about our model of citizenship
21:35was the the significance of the
21:37relational component of citizenship
21:39that came out really,
21:40really strongly in the Scottish
21:42context and that was seen as
21:44particularly important in terms of
21:47developing inclusion and a sense of
21:49belonging for our participants in.
21:52From there we went on to develop a
21:54psychometrically sound measure of
21:56citizenship and that's a 39 item measure.
21:58And again that's been written up and
22:01published in health and
22:02social care in the community.
22:04And my colleague, Dr.
22:05Nicola Cogan, who's on the call in late on,
22:09on that that piece of work.
22:11And that really is a tool that can
22:13be used across health and social
22:15care settings as well as in research
22:18contexts to facilitate conversations
22:20around citizenship as well as to
22:23measure progress around particular
22:25aspects of citizenship that are important
22:28to people with lived experience.
22:31So if we move on now,
22:32gratsy, thank you.
22:35But I think it's also important I
22:37want to highlight that the work of
22:39citizenship in Scotland moves beyond
22:41purely the academic and it has had a
22:44really significant role to play and
22:46practice across Scotland as well.
22:48Just want to highlight an example
22:50of this with our partnership
22:52with Turning Point Scotland.
22:54And that work has been led by our
22:57colleague Karen Black and Citizenship.
22:59And Michael's work there has been
23:01fundamental in terms of the development of
23:04services and support within Turning Point.
23:06And as an organization,
23:08their whole ethos and strategy
23:10is now underpinned by Citizenship
23:12as an approach and a philosophy.
23:15And I think it's a really
23:17brilliant example of good practice.
23:19And next slide please,
23:21please Gratsy,
23:22just to highlight very briefly that
23:23all of the work that we've we've
23:26undertaken in Scotland has been
23:28underpinned by peer research and
23:30working in close partnership with
23:31people with with lived experience.
23:33And this is a group of our peer
23:36researchers here in in this
23:37photograph on on the slide,
23:39we've learned an important number of
23:41important lessons about the importance
23:43of spending time with people.
23:45And you're thinking about
23:47practicalities and value in the
23:49contributions that that people make.
23:51And in that respect with land.
23:52A huge amount from the from Michael's
23:55work and the work of colleagues at Perch.
23:57So I want to finish by moving
23:59to the next slide.
24:00And initially just to give you
24:02a sense of the impact that
24:04Michael's work has had in Scotland,
24:06both on a personal and a professional level.
24:09And I want to finish by with a
24:11quote from my colleague and Dr.
24:13Kirsten McLean and who said Michael
24:15believed in me and I will be
24:17forever grateful that I had the
24:20incredible opportunity to go to Yale.
24:22I will always cherish the experiences
24:24and immersing myself,
24:25myself and Michael's work on citizenship,
24:28the ripple effects of which will be
24:30failed in so many people's lives
24:33for years to come.
24:34And I think that really encapsulates
24:36our thoughts across Scotland.
24:38So thank you,
24:39Michael and I'll now pass on to
24:41our colleague Fiona.
24:48Thank you. Hi, good morning everyone.
24:50My name is Fiona, representing
24:53Richmond Fellowship of Hong Kong.
24:55We are in non government organization
24:57providing community mental health services.
25:00So today I'm going to outline the milestones
25:03and talk about how Richmond Fellowship
25:06implement recovering citizenship in
25:08the services and programs this piece.
25:12In 2019 we had already
25:15started some preparation work.
25:171st, we conducted a focus group to study
25:20the views and concerns of our staff.
25:22If we were going to use the concept
25:25of recovering citizenship in our
25:27services so that we could prepare
25:30earlier and it it is not surprised that
25:32we find that our staff had limited
25:35understanding on recovering Citizenship
25:36and would like to have more guidance.
25:39Therefore,
25:40now we are providing Recovering Citizenship
25:42workshop to all new staff to ensure
25:45that at least they have a fundamental
25:48understanding of recovering Citizenship.
25:50And second,
25:51as we plan to use the citizenship measures
25:54in the Citizens project and casework,
25:57we developed the Chinese version
25:59by translating the original 1 into
26:02Chinese and conducted reliability test.
26:05So the findings have been submitted
26:07to a journal for publication.
26:10Next please.
26:12And in January year 2020,
26:14we have six staff members at 10
26:17training as Yale Persh learning
26:19how to run the Citizens project.
26:23Next please.
26:25So starting from October 2020 till now,
26:28within these three years,
26:30we have delivered six Groups
26:32of Citizens project.
26:33For the first five groups,
26:35we have 40 students graduated and
26:39group 6 will be completed soon
26:41around late October this year.
26:44And in order to sustain the project,
26:46we have trained 18 facilitators,
26:49including peer support workers,
26:51occupational therapists and social workers.
26:54So the citizens project will continue as
26:57a regular service in our organization.
27:00Next, please.
27:03So when we talk about community integration,
27:06I think it is important to know
27:09how the community community look
27:11at recovering citizenship.
27:13Therefore, in year 2021,
27:14we conducted a phone survey to
27:17investigate the knowledge and attitudes
27:19of the community toward recovering
27:22citizenship and mental illness.
27:24So this paper has been published on
27:27the Journal of Public Mental Health.
27:29We interviewed 1009 people and we
27:33found that the general population
27:35has good knowledge of mental health
27:38and around half had heard about
27:40the basic concept of recovering
27:43citizenship and 79 to 94% agree
27:46that people in recovery should
27:49process the five hours next piece.
27:55And in May 2022, because of the COVID,
27:59we were unable to hold our
28:02conference physically.
28:03Therefore, we have a webinar
28:05instead on recovering citizenship,
28:07and we were glad to have Professor
28:09Michael Rowe to be our keynote
28:11speaker to talk about the recovering
28:14citizenship approach in mental health.
28:17And on the other hand,
28:18in the webinar our colleagues also
28:20share their their experience in local
28:23implementation of recovering citizenship.
28:26And in this webinar we have more
28:28than 300 people participate.
28:31Next piece.
28:35This one shows that we created a board
28:38game kit on recovering citizenship for the
28:42promotion in the community. Next piece.
28:48So besides developing the
28:50Chinese citizenship measures,
28:52currently we are also power testing
28:55the the citizenship measures beef,
28:57the one with 12 items.
28:59We want to see if it can be used
29:02as an interviewing tool for new
29:05cases in community setting.
29:07And we also encourage our colleagues to
29:10emphasize the elements of the five hours
29:13when running programs in the community.
29:15So here are two examples.
29:17One is the one is called the
29:21Environmental Volunteers program.
29:22In this program,
29:24the participants help sorting out
29:26garbage which can be recycled.
29:29Another one is called another
29:30program is called
29:34dormitory. So in this program
29:36the participant need to arrange
29:38visits to those residents who
29:40live in our halfway houses
29:42before but have gone back home.
29:45So by participating in
29:47this community programs,
29:48the roles and responsibility in
29:50the community can be enhanced
29:52and and the participants can
29:55also develop and establish
29:56relationship with other people.
30:01Next please and in December this
30:04year we will hold an international
30:06mental health conference.
30:08The main theme is mental Wellness,
30:10recovering citizenship.
30:11So we are very honored to have
30:14Professor Michael Rowe to give a
30:17keynote speech on recovery citizenship,
30:19Miss Mary O'hagan from PSO New Zealand
30:21to talk about collaboration and Professor
30:24Samson said from University of Hong
30:26Kong to talk about strength based care.
30:29Also, we have also invited Miss Patty
30:33Benedict and Doctor Helen Emma from the
30:35Yale Perch to be speakers of the conference.
30:38So thank you very much for all
30:40your support of the conference.
30:42And in the coming years,
30:43we will continue the citizens project
30:46as a regular service trying to
30:48make it more localized and to train
30:50the graduates to be facilitators.
30:52And we will continue incorporating the
30:55five hours concept into our services
30:57and programs and to promote our see,
31:00I mean the recovery,
31:02citizenship across community stakeholders.
31:04So this is the end of my presentation.
31:06Thank you very much.
31:07And now I'm going to turn it to Erica.
31:10Thank you.
31:12Hi.
31:12So I'm Erica Carr and I might yell
31:15Connecticut Mental Health Center.
31:16And today I get the pleasure of
31:19and just extreme honor of talking
31:21with this talented group of people
31:23about citizenship and how that
31:25relates to inpatient settings.
31:26I know this is very different to think about,
31:29but I I think also never is more
31:32important than when you think
31:33about the fact that people have
31:36to sometimes go within inpatient
31:38settings and a door is locked on them.
31:40So I'm going to talk about using positive
31:42behavioral supports as a means to gain
31:44citizenship from behind those locked doors.
31:47And positive behavioral supports is
31:49basically a way of managing challenging
31:51behaviors that sometimes occur on
31:54inpatient settings with non punitive,
31:56non coercive methods.
31:57So our idea is basically trying to
32:00understand why do these behaviors
32:02occur in these settings and it's it's
32:05very interesting and why they occur.
32:06I think it a lot of it relates to the
32:08fact that it's an artificial environment.
32:10It's not like the real world,
32:12right?
32:12You you're not really a citizen there
32:14in many ways because your rights have
32:16been stripped from you in many ways.
32:18If you've been involuntarily hospitalized,
32:20you may be involuntarily medicated as well.
32:23So it's a it's a very unusual
32:25environment people find themselves.
32:27So we want to understand why
32:29challenging behaviors occur,
32:31teach new skills that for the individuals
32:34they can communicate effectively.
32:35But just as importantly or more importantly
32:37understand ecologically what is going
32:40on and what is the environment need
32:42to do so that that skill isn't needed.
32:45And that speaks I think hugely,
32:48is that there's something about
32:50the environment.
32:51A lot of times it brings up these behaviors.
32:54Next slide please.
32:56So how does this map onto the
32:58ideal of citizenship?
33:00PBS at its core is the idea
33:02that we want everyone to have a
33:04meaningful life and that we want
33:06it to be very person centered.
33:08Avoid.
33:28I think Erica froze.
33:29The fact that they want to they
33:32want to have a girlfriend again.
33:34They want to go back to work.
33:35They want to go back.
33:47Hopefully she'll be able
33:48to get back on with us.
33:49I'm going to start off.
33:52We're honored to be here today
33:54to talk about Michael's inspired
33:56so many of us in so many ways.
33:58So we're going to talk a little bit about
34:00some of the applications of citizenship
34:02here in New Haven that we've worked on.
34:05Collective citizenship was defined in
34:07a 2019 paper by Michael and colleagues
34:10as a response to the individualizing
34:12tendency of mental health services.
34:14In collective citizenship.
34:16Power belongs to the group,
34:17not to the service providers.
34:19To dole out, service providers must
34:22earn trust as common cause partners,
34:24not automatically assume the role of leader.
34:27This requires A deliberate,
34:29often challenging power shift in
34:32power from service providers.
34:342 people in recovery as valued
34:36community members,
34:37not as disempowered or socially
34:39isolated patients or clients.
34:41It requires intentional solidarity.
34:42And I'm going to turn it over to
34:44Bridget to talk a little bit more
34:46about our approach.
34:48Thank you.
34:51Thank you so much.
34:52My computer's tripping right now.
34:53But however, I just think it's very
34:57important that we literally come outside
35:00he was because a lot of times when we
35:04going to the agencies that we only spend
35:06like 1/2 an hour or hour there or less,
35:09we coming back for a group
35:10or something like that.
35:12But the majority time we are
35:13out here in the community.
35:15So I just think that the meat
35:17and potatoes are out here,
35:19we already here.
35:20So I just think the key to coming out
35:24here is to the into that community
35:28because it's so important for us of
35:31important how we go into there is to,
35:35you know, go in with opening ears
35:38and listening because it's not
35:42the expertise behind the walls,
35:44it's the expertise that's in that community,
35:46where they at,
35:47because we know how to survive.
35:49Not only that,
35:50I need folks to know that when we are
35:54there or in the community that we are
35:57capable of making our own decisions.
36:00Like I don't need someone to control my
36:03space and drive my car because the best
36:06person to drive your car is yourself.
36:08So once we teach people how to,
36:11you know, move forward,
36:13because everything has to
36:15be a shared decision,
36:17it cannot come from the provider.
36:20Again, I'm driving my car.
36:22So once we feel hopeful to do that,
36:26you basically can get folks
36:27to do whatever you want,
36:29but do more listening when you're coming
36:31to the community than controlling the
36:34space and putting in your own agenda.
36:36We are very resilient people.
36:39And as I move forward in life,
36:41I lift people up and bring her with me.
36:44I don't leave people behind.
36:45I think that's very important.
36:49So I'm going to share a little.
36:50Thanks, Bridget. I'm going to
36:51share a little bit about some of
36:53the groups that Bridget and I work
36:54with here in New Haven as part of
36:56our collective citizenship work.
36:58We've been fortunate to work with Focus,
37:00Act, Connect every day, or FACE,
37:02which is a meeting in coffee shops
37:05across New Haven since about 2015,
37:07and then we met weekly on Zoom.
37:09During the pandemic,
37:10the collective operates on Consensus.
37:13It's makes it very clear that it is not
37:15specifically a mental health group,
37:17and it's focused very much
37:18on community building,
37:19though mutual support around mental health
37:21struggles is a key part of the group.
37:26Here, Faces, pictured making
37:29a coordinating A mural at a
37:30neighborhood festival in New Haven,
37:32as well as packing groceries at an
37:34annual food drive that we do every year.
37:36And here in New Haven,
37:38we did some qualitative interviews
37:40with members of FACE and found
37:42that that face gives a strong sense
37:45of ownership over the collective.
37:47It decreased social isolation
37:49against indicated,
37:50stronger connections to the community,
37:52increased hope and the sense of agency.
37:55Witnesses to Hunger,
37:56also pictured as a collective of
37:58New Haven residents with personal
38:00experiences of poverty who organized
38:02around Food Insecurity and 2018.
38:05We helped get them get started
38:09and we've been Bridget,
38:11particularly as in bringing members into
38:14that group and getting them oriented
38:15to what the collective is doing.
38:17We've also provided support,
38:19along with our colleague Andy
38:21Harper and Bridget,
38:22in helping the group to develop
38:24advocacy strategies as partners,
38:26securing grant funding,
38:28organizing photo voice exhibits,
38:30connecting with food security coalitions
38:32that are operating around the city.
38:34Witnesses pictured here on the upper
38:36left at a press conference at City
38:39Hall announcing food summer meals,
38:41program for kids.
38:42And in the picture,
38:43I want to acknowledge Witnesses leader
38:44Wanda Perez, who recently passed away.
38:47We went Rest in Power Wanda and then
38:50the last group pictured here is
38:52during Michael's final year at Perch.
38:55We were asked,
38:55we were approached and asked to
38:57organize with a group of Unhoused
38:59leaders and and Housed allies to form
39:01the Unhoused Activist Community Team,
39:03otherwise known as U Act.
39:06The group is pictured here rallying
39:07in support of Keith Petrulis
39:09who was one of our leaders,
39:10unhoused leaders who was kicked out
39:13of his place where he was living
39:16in an entryway down in 9th square.
39:18He later passed at at another
39:21outdoor location downtown.
39:23So I want to acknowledge him
39:24and and rest in power.
39:25Keith, he was a good friend of ours.
39:28We provide support.
39:29The Perch team provide support to you ACT
39:31leaders in cofacilitating the weekly groups,
39:34doing outreach,
39:35other activities of the group
39:37and community organizing support.
39:40And they're we we support them in
39:42their demands that the policymakers
39:44acknowledge and eliminate the
39:46trauma that's caused by the de facto
39:48criminalization of homelessness
39:49here in New Haven.
39:50We've also taught residents and
39:53fellows through the citizenship lens,
39:55mostly through the social justice
39:57and HealthEquity curriculum here
39:58in the department.
39:59And Bridge is going to talk a
40:00little bit more about that.
40:03Thank you again, Bill. So the residents,
40:06I love to take the residence.
40:08I think I've been doing that for like 5 or
40:10six years and the reason why I really could.
40:13Commit to doing that is because for one,
40:16I don't want the residents to
40:18be making movies about what
40:19they think about Dixwell Ave.
40:21because you hear so much,
40:22you know negative stuff about Dixwell.
40:24So I like to keep it 100 with
40:26them and tell them the truth in
40:28the history of about Dixwell Ave.
40:31Not only that,
40:32but before I take them out,
40:34I go through Dixwell Avenue.
40:35I go to the leaders there,
40:38the block watchers,
40:39the drug dealers and let them know
40:41that I'm coming through there with
40:43the residents so that we can be
40:45able to get through there safely.
40:47And not that I'm bringing, you know,
40:49police or or people to set them up.
40:52So I think that's important to let the
40:54community know that I'm coming through
40:56and then when I come through there,
40:58it's really weird because you know,
41:00academia folks are so used
41:03to controlling their space.
41:04It's like the road switch.
41:06Now they in my court and you know,
41:09I'm a basketball player used to be.
41:11So when I say court, they in my space.
41:14So now the road switch,
41:15you're listening to me and to see
41:19that happening and see all the
41:21questions that's being asked about
41:24the community that we walking through.
41:26But I really tell them more than
41:29the truth because I got over 60
41:31years of experience on Dixville.
41:33So I need them to know all
41:35the stuff that's happening.
41:37So when they are meeting
41:39folks inside their community,
41:41that meeting folks inside their office,
41:43they have a little idea of, you know,
41:46where the person is coming from.
41:47But not just that.
41:48I don't need them to come through
41:50just to do that drive by when
41:52I bring them through that,
41:53I need them continue on coming through
41:56there because relationships are the
41:58key to helping people move forward.
42:01And another thing I just want to say,
42:03I appreciate you, Michael,
42:04for putting me on your team
42:07because without you,
42:08I don't know where I'll be at.
42:10And Doctor Belly,
42:11and I also want to thank you for seeing
42:13stuff in me that I didn't see in myself.
42:15Thank you,
42:17Michael Rowe.
42:18And
42:18I also want to say thanks to Michael
42:20for teaching us how to actually do
42:21citizenship and taking out of the
42:23conceptual and making an actual thing
42:25that makes differences in so many lives.
42:27And I also want to thank you for encouraging
42:29us to find the edge of of citizenship,
42:31Michael, and to continue to push
42:33through that edge and make innovations.
42:35So thank you. And we're going to hand
42:37it over to our colleague, Allison.
42:48I'm sorry, my computer just throws up.
42:50Can you see me now and hear me,
42:51Okay? Great. Thanks.
42:53Thank you, Bridget.
42:54And Billy, I'm Allison Ponce.
42:56I'm a clinical psychologist and
42:57professor in the Department
42:58of Psychiatry here at Yale,
43:00and I'm based at Connecticut
43:01Mental Health Center.
43:03So I'd like to talk
43:04a little bit about how citizenship
43:06has actually affected us as scholars
43:08and mentees and colleagues.
43:10And wondering with you about how our
43:12engagement with this work has broadened
43:14our views of our own citizenship and
43:16our own enactment of the five R's.
43:18We've heard lots of descriptions
43:19today about how the model has
43:21been implemented with different
43:23populations in different countries
43:24with widely varied applications,
43:25and I can add to this list.
43:27I've been lucky to be involved
43:29in this work over the years,
43:30thinking about how it applies
43:31to different populations,
43:32people who have just as involvement,
43:34people with serious mental illness,
43:36people without homes.
43:39Sorry about the siren here,
43:41but what strikes me is all of the ways
43:43that the model itself is actually created.
43:45Community.
43:46Just look at this panel today. People
43:47from all over the world,
43:50so sorry about that,
43:52who have been drawn to this concept,
43:54the universality of the idea
43:56that these fundamental elements
43:58are crucial to having a full and
44:00meaningful life in the community.
44:02So I'd like to suggest that we reflect
44:04for a couple of moments about why
44:05this resonates for
44:06us. What does it feed in us?
44:09How does awareness of the citizenship model,
44:11whether you helped create it or you're
44:13hearing about it today for the first time,
44:15how does it change not just the way
44:16we think about other people's access
44:18to citizenship and how it applies
44:20to each of us?
44:22I think the answer is
44:24completely person dependent.
44:25How I experience responsibility
44:26or roles or relationships is
44:29different than how you do.
44:30But the fact that these ours
44:32undergird our shared human experience
44:34is really on display today,
44:36as we hear from colleagues and
44:38Quebec and Hong Kong and Spain and
44:40Scotland and here in New Haven.
44:42So I'd like to invite you
44:43to think about this.
44:44How can an interrogation of our
44:47own connections to the five R's,
44:49the elements that connect us to one
44:51another and to our experience of the world,
44:53how can that help us discover new ways
44:55to use the citizenship model to move
44:58it even further out into the world,
45:00to impact even more people and
45:03more structures and more systems?
45:05So I recognize we're getting
45:06a little short on time now.
45:07So I'll,
45:07I'll end my remarks because I think
45:09we all want to hear from Michael.
45:11And without Michael,
45:12none of this work would be possible.
45:14And I'm very grateful for all of
45:16the sort of care you've taken
45:18of me as a colleague.
45:19Michael and I pass it on to you.
45:27Thank you. Allison.
45:30My screen just changed. Can you see me?
45:36And Good morning all and 1st I'm going
45:38to thank all of the presenters for your
45:41citizenship work and your kind words.
45:43The reason there's any praise to give
45:45me is the reason I have to praise
45:46you and others who do this work,
45:48which otherwise would have sunk like a stone
45:51in the early 2000s but instead is floating.
45:55It's even sailing.
45:57So thank you many others to thank,
46:01but lack of time today.
46:03Other other names will be added to
46:05the PowerPoint on the department's
46:07website for this brand rounds.
46:09But I must acknowledge doctor Cheryl
46:12Bellamy for the idea of having this forum
46:15and Grazio Reese for coordinating it.
46:17Also want to acknowledge Patty Benedict,
46:19the heart of our citizenship
46:20work for many years.
46:22And remember Leslie Two Bears fondly.
46:25I also want to acknowledge DAMAS for
46:28their long time support for this work.
46:31So I just have just a few minutes
46:33to make five points about innovation
46:36in community mental health with
46:38citizenship as the case example.
46:40So my first point is have a
46:42promising idea or a hypothesis that's
46:44based on some evidence,
46:46although the evidence may be that
46:48of observation in depth interviews
46:51or consideration of a concept.
46:53So if the current idea for
46:56creating an integrated system of
46:58care is called No Wrong Door,
46:59you get in one door and
47:00you get into all of them.
47:02You may be walking down the
47:03street one morning and think,
47:04Oh my God,
47:05we forgot to think about who would
47:07be at the door to let people in.
47:11Second point,
47:11heaven and help to create a hub
47:13that brings creative people
47:15together and keeps the work going.
47:17Perch has been that hub at Yale,
47:19C&amp;HC for Annie, Billy, Bridget,
47:23and many others.
47:24I think the School of Social Work and
47:27Social Policy at the University of
47:30Strathclyde has been a hub for Jillian
47:33and the Richmond Fellowship for Fiona.
47:36Third Point reach out to
47:39and involve connectors.
47:40Eric,
47:41ahead of the inpatient Psychology
47:43service for CMHC,
47:45is a new citizenship connector.
47:48Ellis and Director of Education
47:50at CMHE is a long time partner in
47:52this work and a link for ongoing
47:54citizenship educational work
47:56and training at CMHC and Dean is
47:58through the Recovering Citizenship
48:00Learning Collaborative.
48:03Doctor Pelletier is a is a connector,
48:05cofounder of the International
48:07Recovery and Citizenship Collective
48:09starting around 2012 with perch,
48:12demis and a bumpy ride to the
48:16University Of Montreal on a prop
48:18plane that the pilot had to move
48:20us around on to get the weight
48:22balanced on both sides of the aisle
48:25That is now an 11 nation collective
48:27across four or five continents.
48:31Francesco is a connector, too,
48:33for academics, peers, clinicians in Spain,
48:37Caledonia for citizenship work.
48:41Fourth point Innovation in mental
48:44health doesn't involve only coming up
48:46with fixes for identified problems,
48:49but uncovering problems or gaps that
48:52haven't been fully conceptualized before.
48:55Financial health in in
48:57community mental health.
48:58Where did you hear of that until
49:01you heard of Annie Harper?
49:05Community training for residents
49:07in psychiatry by peers,
49:09community organizers and community guides.
49:12Where did you hear about that before
49:14Doctor Rohrbaugh, Billy Brumage,
49:16Bridget Williamson and others?
49:18Citizenship as Health Francesco Aeroa Rosa.
49:25Fifth Point Values stand
49:29behind techniques and training.
49:32Allison talking about the
49:34aspirational nature of citizenship,
49:36which seemed obvious to her,
49:38but naming it made a difference.
49:41Fiona embracing and extending the idea of
49:44recovering citizenship from a 2016 paper,
49:47From Perch to a new direction for the work
49:50of the Richmond Fellowship in Hong Kong.
49:53Jillian and colleagues practicing a
49:55community and people wide approach to
49:58mental health from their base in Glasgow.
50:02Billy Brummage bringing the values
50:04of community organizing to the
50:06practice of collective citizenship.
50:09Bridget Williamson and and Jean
50:11Francois bringing different
50:13approaches and inspiration to pure
50:16work training and empowerment.
50:18And finally I would say look to
50:20your professions for values to
50:22guide and support your work.
50:24Psychiatry, peer work,
50:27psychology, social work, nursing,
50:31case work, case management.
50:34Do they support the values behind
50:36citizenship, recovery, anti racism,
50:38social equity and inclusion?
50:43Billy and I did a little bit of work
50:45looking at some of the professions
50:48and and felt that if you looked,
50:50if you really looked at them,
50:51they were supporting most of these values.
50:55So if they are supporting them, that's great.
50:58If they're not, they should.
51:00And if they do support them,
51:02they not only back you up,
51:03but they require you to bring
51:05those values to your workplace.
51:08And I think I'm pretty much out of
51:09time and we wanted to leave a little
51:11bit of a bit of time for questions.
51:13So I will turn it back to Doctor
51:16Harper Annie Harper for Q&amp;A.