Occupational Therapy in Mental Health
Occupational Therapy in Mental Health
Occupational Therapy in Mental Health
To cite this Article Swarbrick, Margaret(2009) 'Collaborative Support Programs of New Jersey', Occupational Therapy in
Mental Health, 25: 3, 224 — 238
To link to this Article: DOI: 10.1080/01642120903083952
URL: http://dx.doi.org/10.1080/01642120903083952
The publisher does not give any warranty express or implied or make any representation that the contents
will be complete or accurate or up to date. The accuracy of any instructions, formulae and drug doses
should be independently verified with primary sources. The publisher shall not be liable for any loss,
actions, claims, proceedings, demand or costs or damages whatsoever or howsoever caused arising directly
or indirectly in connection with or arising out of the use of this material.
Occupational Therapy in Mental Health, 25:224–238, 2009
Copyright # Taylor & Francis Group, LLC
ISSN: 0164-212X print=1541-3101 online
DOI: 10.1080/01642120903083952
MARGARET SWARBRICK
Institute for Wellness and Recovery Initiatives Collaborative Support Programs
of New Jersey, Freehold, New Jersey
University of Medicine and Dentistry of New Jersey, School of Health Related Professionals,
Department of Psychiatric Rehabilitation and Counseling, Scotch Plains, New Jersey
Downloaded By: [Swets Content Distribution] At: 16:33 11 November 2010
INTRODUCTION
This manuscript has revealed the vast array of practical services and
resources that have been designed and delivered by persons living with
mental illness. This article will present a unique service organization, Colla-
borative Support Programs of New Jersey (CSP-NJ). This agency is
considered a leader in creating a vast range of these resources designed to
meet the needs of people living with mental illness. The history of CSP-NJ
parallels the mental health consumer-survivor self-help movement described
in the article ‘‘Historical Perspective—From Institution to Community’’
(this issue). Many of the services portrayed in this issue (self-help centers,
wellness, and recovery programs and the peer employment support project)
were conceived by leaders and innovators at CSP-NJ. This section will offer a
snapshot of some of the other CSP-NJ innovations in order to further demon-
strate how peer-operated services can be an instrumental resource for mental
health systems transformation.
CSP-NJ HISTORY
224
Collaborative Support Programs of New Jersey 225
mental illness, as perceived not only by themselves, but also the general
population. As they have expanded and diversified, they have continually
challenged themselves to keep abreast of new and effective means of
delivering services. A quality improvement (QI) initiative started in 1998,
and in 2003 the agency adopted a Participatory Action Research (PAR)
approach to QI, out of which was created the Consumer-Operated Mission
Performance: Assessing Services Strategically (COMPASS), an agency-wide
outcomes-based measurement system designed to evaluate the effectiveness
of the CSP-NJ and CEC programs and services.
CSP-NJ believes strongly in work, and the expansion of the agency
services created employment opportunities for many people living with
mental illness. Within all of the services they attempt to help people
transcend the patient role so people who are diagnosed with a mental illness
Downloaded By: [Swets Content Distribution] At: 16:33 11 November 2010
can realize and have opportunities to further develop talents, skills, and
abilities so they can participate in as many roles as they define (family
member, worker, community member, citizen of the world, hobbyist, etc.).
The agency’s success and services also impact stigma and discrimination,
as they are evidence that people living with mental illness can accomplish
goals, dreams, and provide a positive contribution to society. The following
section will describe some information regarding services not previously
outlined in this issue.
CSP-NJ SERVICES
Support Services
The support services division of CSP-NJ offers flexible, strength-based
services designed to promote wellness and recovery. As of 2009, the agency
offers statewide support services to about 400 persons living with mental
illness. They offer a menu of support services that help people live success-
fully in safe, decent, accessible, and affordable housing. The support services
division has been placing a lot of focus on offering opportunities for indivi-
duals who may be unnecessarily hospitalized in state facilities for extended
periods of time.
The agency believes that psychiatric rehabilitation values, principles,
and goals (Pratt, Gill, Barrett, & Roberts, 2007) best promote wellness and
recovery, and they have committed themselves to maintain and provide
services that are guided by the psychiatric rehabilitation framework. Staff
has been trained extensively on psychiatric rehabilitation goals, values, and
principles, so that they are able to empower persons served to achieve
valued life roles. The agency supports people’s efforts to return to work
and=or school. Sixty-eight percent of the support service staff has obtained
the Certified Psychiatric Rehabilitation Practitioner (CPRP) certification. This
skill set and knowledge base prepares staff to empower the people they
Collaborative Support Programs of New Jersey 227
serve to strengthen their natural support systems and help them create a
personal Wellness and Recovery Action Plan (WRAP) as a means of averting
and=or managing personal crises.
Support services will continue to evolve to improve ways of promoting
community integration and offering access to further opportunities for com-
munity participation. CSP-NJ believes that work, in particular, is an important
component of recovery, and they are committed to helping individuals return
to the workforce. In light of the alarmingly high rates of co-morbidity and
early mortality among people living with mental illnesses, they have consid-
erable work to do toward promoting healthy lifestyles for both the staff and
the people they serve.
Personal preference When someone is given options and their personal preference
(provision of options and is respected, they feel a greater sense of control,
choices and the respect responsibility, and ownership, which leads to more positive
for choices made by the outcomes. Providing options in the form of living
individual) arrangements and supports offers an empowering
experience, which can maximize opportunities for success.
Mainstream housing (access Persons served are assisted with locating mainstream housing
to community housing sites that maximize community integration and promote
that is decent, attractive, independence. The security of knowing that one’s home will
safe, affordable, not be taken away in the event of hospitalization promotes
accessible, and emotional stability. Homes are located in neighborhoods
permanent) that are close to shopping, public transportation, and
recreational opportunities.
Flexible support services Availability of flexible support services based on individual
(linkages to flexible need rather than on program protocol empowers the
supports that are provider to work collaboratively with the individual
individualized, accessible, holistically, which avoids prescriptive services that engender
and consistently dependency. Services are available at various levels of need
available) and respond to the consumers’ changing needs. Support
appears to be a critical factor in determining whether people
can integrate into the community—accessible and consistent
support can mean the difference between remaining in one’s
home and developing symptoms that force the person
served to be hospitalized.
228 M. Swarbrick
ery, and move toward higher levels of well-being. The combination of per-
manent housing with independent service does not require that the person
move as they get ‘‘better’’ or as they experience stressors that exacerbate
symptoms.
Self-Help Centers
For more than 20 years, CSP-NJ has recognized the power of self-help and
what it can do in the lives of mental health peers. CSP-NJ self-help centers
are freestanding, community-located sites that are designed to offer a safe,
comfortable environment where mental health peers can socialize with
peers, meet new people, learn new skills, join self-help and advocacy
groups, and enjoy recreational activities (Swarbrick & Duffy, 2000; Swarbrick,
2005). The idea of ‘‘not being alone,’’ the value of knowing the experience
‘‘from the inside out,’’ and the opportunity to provide and receive help offer
a unique perspective that helps people improve the quality of their lives and
their sense of well-being (self-help centers are described in further detail in
‘‘Collaborative Support Programs of New Jersey’’ and ‘‘Peer-Operated
Self-help Centers’’ [this issue]).
In 1985, CSP-NJ was able to take the ideas of self-help and mutual aid
and put them into practice with the initial establishment of three
peer-operated drop-in centers: Social Connections in Clifton, The CARE
Center in Asbury Park, and New Horizons in Vineland. With the formation
of just those three drop-in centers, no one could have predicted the
expansion of and changes in peer-operated services to meet the need
for services run by and for peers statewide that would follow. In 1997,
the number of drop-in centers increased significantly with 12 new centers
and had a new name: ‘‘drop-in’’ was changed to ‘‘self-help’’ to reflect the
growing recognition of the idea of self-help as being a valuable tool for
promoting recovery and wellness. In 2005, the NJ Division of Mental
Health Services further recognized the importance of self-help centers
as part of the continuum of services for mental health peers. Additional
funding allowed CSP-NJ to provide over 20 full-time positions for peers
as self-help center managers to improve conditions for members by
moving and renovating centers and expanding services to reach more
peers and meet changing needs.
230 M. Swarbrick
Wellness Model
The agency embraced the wellness model in 1998. We observed that adults
living with mental illnesses are becoming seriously ill and dying, even
while under the care of the mental health system. They were developing
chronic medical diseases that significantly shorten their lives. At that time,
people living with psychiatric disabilities died about 15 years earlier than
the general population, and, as of 2006, statistics indicate that people die
25 years earlier. Sixty percent of premature deaths are due to medical con-
ditions such as cardiovascular, pulmonary, and infectious diseases (National
Association of State Mental Health Program Directors Council [NASMHPD],
2006).
These serious health problems are frequently caused or worsened by
controllable lifestyle factors (physical activity, smoking, access to adequate
healthcare and prevention services, diet and nutrition, and substance abuse,
as well as others).
Since mortality and morbidity are linked to high rates of modifiable
risk factors, including smoking, alcohol consumption, poor nutrition=
obesity, lack of exercise, unsafe sexual behavior, IV drug use, residence in
Collaborative Support Programs of New Jersey 231
syndrome.
In 2007, the Center for Mental Health Services (CMHS) launched the
National Wellness Summit for People with Mental Illness. The heart of this
summit is the ‘‘10 in 10’’ campaign, which strives to improve the life
expectancy of individuals with serious mental illness (SMI) by 10 years,
and to achieve this goal within 10 years. Currently, individuals with SMI
have a lifespan that averages 25 years less than the general population,
due not only to SMI but also various comorbidities, such as diabetes
and heart disease. At its summit, CMHS also introduced ‘‘The Pledge for
Wellness,’’ which includes the goal of the ‘‘10 in 10’’ campaign. All health
and mental health provider organizations, individuals, and government
entities are strongly encouraged to make the pledge. CSP-NJ staff was
involved in this event and are making great efforts to help address this
unacceptable healthcare disparity impacting persons living with mental
illness. We have made a commitment to help persons in recovery, their
supporters and families, and the system to embrace wellness. Words of
Wellness is one such vehicle.
Words of Wellness
As part of its broad array of services to foster wellness, recovery, and
economic self-sufficiency for individuals with disabilities, the Institute for
Wellness and Recovery Initiatives and Collaborative Support Programs of
New Jersey (CSP-NJ) offers a monthly newsletter, Words of Wellness. The
Institute also regularly disseminates practical wellness information through
this venue. This publication features valuable information and resources,
including details about educational events to help people achieve and
maintain wellness. The purpose of this newsletter is to bring useful informa-
tion to all of our readers, whether pursuing recovery themselves, supporting
recovery in clients or family members, helping to administer and change our
mental health and related services system, or researching the field and
232 M. Swarbrick
INSTITUTE ACTIVITIES
The agency hosts an Annual Wellness Conference, which has become known
as the premier education and networking event in the area of wellness and
recovery for the mental health community throughout New Jersey. The
two-day event has featured workshops and institutes that combine topics
of interest with practical and experiential elements. The conference has been
able to attract persons living with mental illness, peer providers, family
Downloaded By: [Swets Content Distribution] At: 16:33 11 November 2010
members, and policy-makers who are able to network and learn more about
roles and responsibilities for moving the system toward one that is fully
wellness and recovery oriented.
Recovery Network
The Recovery Network Project, a peer-delivered wellness and recovery
education program that started in 2004 (described in ‘‘Designing a Study
to Examine Self Help Centers’’ [this issue]), is based on the renewed hope
and optimism that people diagnosed with a mental illness can grow
beyond the preconceived limits of their diagnoses and live a full life
(Swarbrick & Brice, 2006). Peer educators (persons living with mental ill-
ness who identify themselves as in recovery) share resources and personal
experiences that can help others begin their own recovery journey
(Swarbrick & Brice, 2006). The content of the presentations provides a
clear message of hope and exposes participants to the array of self-help,
wellness, and recovery resources available (Swarbrick & Brice, 2006). Peer
educators facilitate groups one day per week with patients and staff at state
psychiatric hospitals in New Jersey. The project also offers wellness and
recovery training for the state hospital’s new employee orientation
program.
COMPASS
LESSONS LEARNED
as possible.
REFERENCES
Carling, P. (1993). Housing supports for persons with mental illness: Emerging
approaches to research and practice. Hospital and Community Psychiatry,
44, 439–449.
Carling, P. (1995). Return to community: Building support systems for people with
psychiatric disabilities. New York: Guilford Press.
Collaborative Support Programs of New Jersey. (1996). Boarding home resident
survey for Monmouth and Ocean County. Unpublished manuscript. Freehold,
New Jersey.
Collaborative Support Programs of New Jersey. (1991). Consumer housing prefer-
ence survey: Results and executive summary. Unpublished manuscript.
Freehold, New Jersey.
Delman, J. (2006). Consumer-driven and conducted research in action. In T. Kroll
(Ed.), Towards best practice for surveying people with disabilities. New York:
Nova Science.
National Association of State Mental Health Program Directors Council (NASMHPD).
(2006). Morbidity and mortality in people with serious mental illness (13th in a
series of technical reports). Alexandria, VA: Author.
Minsky, S., Riesser, G., & Duffy, D. (1995). The eye of the beholder: Housing prefer-
ences of inpatients and their treatment teams. Psychiatric Services, 46, 173–176.
McTaggert, R. (1997). 16 Tenets of Participatory Action Research. In Y. Wadsworth,
(Ed.). Everyday evaluation on the run. Australia: Allen & Unwin.
O’Hara, A., & Day, S. (December, 2001). Olmstead and supportive housing: A vision
for the future. Center for Health Care Strategies, 1–29.
Parks, J., Svendsen, D., Singer, P., Foti, M. E., & Mauer, B. (2006, October). Morbidity
and mortality in people with serious mental illness [Technical Report]. Retrieved
June 12, 2008, from http://www.nasmhpd.org/general_files/publications/med_
directors_pubs/Technical%20Report%20on%20Morbidity%20and%20Mortality%
20-%20Final%2011-06.pdf
238 M. Swarbrick
Pratt, C. W., Gill, K. J., Barrett, N. M., & Roberts, M. M. (2007). Psychiatric rehabilita-
tion (2nd edition). San Diego: Elsevier.
Swarbrick, M. (2005). Consumer-operated self-help centers: The relationship
between the social environment and its association with empowerment and
satisfaction. Unpublished manuscript. New York City, NY: New York University.
Swarbrick, M. (2006a). A wellness approach. Psychiatric Rehabilitation Journal,
29(4), 311–314.
Swarbrick, M. (2006b). Asset-building financial self-management support model: A
promising practice. Journal of Psychosocial Nursing, 44(10), 22–26.
Swarbrick, M., & Brice, G. (2006). Sharing the message of hope, wellness, and
recovery with consumers and staff at psychiatric hospitals. American Journal
of Psychiatric Rehabilitation, 9, 101–109.
Swarbrick, M., & Duffy, M. (2000). Consumer-operated organizations and programs:
A role for occupational therapists. Mental Health Special Interest Quarterly,
23(March), 1–4.
Downloaded By: [Swets Content Distribution] At: 16:33 11 November 2010
Swarbrick, M., Hutchinson, D., & Gill, K. (Summer, 2008). The quest for optimal
health: Can education and training cure what ails us? International Journal of
Mental Health, 37(2), 69–88.
Wallerstein, N., & Duran, B. (2003). The conceptual, historical, and practice roots of
community based participatory research and related participatory traditions. In
M. Minkler & N. Wallerstein (Eds.). Community based participatory research for
health. San Francisco: Jossey Bass.