PIER Program Conference: “Intervening Early to Improve Outcomes for Youth with Psychosis”

On Monday, May 9, our friends at the PIER Program are hosting a half-day conference, “Intervening Early to Improve Outcomes for Youth with Psychosis,” at the Abromson Center at the University of Southern Maine in Portland. Check out the flyer below for more details, and register here.


World Premiere of “Healing Voices” at the Boston International Film Festival

Healing Voices is a new feature-length documentary which explores the experiences commonly labeled as “psychosis” or “mental illness” through the real-life stories of individuals working to overcome extreme mental states, and integrate these experiences into their lives in meaningful ways. Oryx Cohen, MPA, one of the film’s subjects and producers, will be joining us on May 20 to give a keynote presentation at this year’s HOPE Conference.

Written and Directed by PJ Moynihan of Digital Eyes Film, Healing Voices asks the question: “What are we talking about when we talk about ‘mental illness’?” The film follows three subjects – Oryx, Jen, and Dan – over nearly five years, and features interviews with notable international experts including: Robert Whitaker, Dr. Bruce Levine, Celia Brown, Will Hall, Dr. Marius Romme, and others, on the history of psychiatry and the rise of the ‘medical model’ of mental illness.

The documentary is ideal for individuals with lived experience in the mental health system, educators, peer counselors, advocates, researchers, psychiatrists, psychologists, healthcare workers, first responders, family members, or anyone who has been touched by mental health issues in their life.

“What we refer to as ‘mental illness’ in our culture is widely discussed and debated, but not very well understood,” said Moynihan. “These screenings are an opportunity for a range of demographic groups to come together and engage in a dialogue about a very complex social issue.”

Healing Voices will have its World Premiere at the Boston International Film Festival on Saturday, April 16 at 11:30 am at the Broadway Theater, 26 West Street, Boston, MA. The trailer is available on YouTube, and a full scene has recently been released exclusively on Mad in America.

Click here to get tickets and select “Session 8” for Healing Voices.

Healing Voices Invite

Photos from our 2015 Membership Meeting

Our 2015 Annual Meeting took place on November 17 at the USM Wishcamper Center in Portland. The day began with a show of appreciation to our member organizations through plaques presented by CCSME Board President Simonne Maline:

CCSME Annual Meeting — Nov. 17, 2015

CCSME Annual Meeting — Nov. 17, 2015

Following the awards national speaker Ron Manderscheid, Ph.D., Executive Director of the National Association of County Behavioral Health & Developmental Disability Directors and Adjunct Professor at Johns Hopkins Bloomberg School of Public Health, gave the keynote presentation, “A Changing Landscape: How National Trends in Behavioral Health Affect Your Practice.”

The afternoon included workshops — led by CCSME board members — on recovery-oriented systems of care, co-occurring practice in behavioral health homes, medication-assisted treatment and recovery, and mental illness at the pretrial stage. Dr. Manderscheid joined each workshop in turn to lend a national perspective to the discussions.

Materials and resources from the keynote and breakout sessions are available on our website.


My Experience Is My Strength

Mike Blanchard is a Peer Services Innovator at Amistad, Inc. in Portland, Maine. He is an experienced mental health worker and is also engaged in his own recovery.

Peer services innovation is part of a SAMHSA networking grant. Our approach when we wrote the grant was specifically to network with folks who are currently working in peer support jobs but also to try to be that bridge between providers and consumers. There are some great consumer organizations in this state and we want to work in tandem and in concert with these organizations. One of our ultimate goals is to encourage providers and policymakers to create more state peer support positions.

Amistad believes peer support should be available to everyone. It shouldn’t be delivered based on whether somebody has MaineCare or not. The mental health consumer that’s struggling… many times feels marginalized because the system is set up in a fee-for-service structure. The very people we want to reach are going to be screened out due to insurance eligibility.

Peer support is… about someone who’s been there. The story I like to tell people is that I was a mental health worker for about four years and had taken people to a local psychiatric hospital and sat with them during that process of being admitted for a psychiatric emergency. I thought I knew what that process felt like. Then one day, at seven years clean and sober, I walked into a psychiatric intensive care unit and was in pajamas and did not have access to leave.

Everything I knew about mental health as a provider changed at that moment. When that door shut behind me, I knew things were radically different than what I perceived them to be as a provider. Dressed in scrubs and with no visitor’s tag, I was locked in. I will never forget the sound of that door shutting. That’s a knowledge base that cannot be learned, it can only be experienced.

That’s the magic of peer support. Peer support starts from a place with understanding, dignity and respect because we’ve been there. We know what it’s like on a level that is experiential. That offers us credibility with the very peers we are trying to help.

I continued with both my recovery and my work in the mental health/substance abuse field. In 2007, I began working at the local psychiatric hospital as a mental health tech part-time. After about a year, I got a job at Amistad as the Peer Patient Navigator. I would help members at Amistad who had physical and mental health issues access quality health care. Part of my duties included coming out to the membership as a mental health consumer.

I still worked nights and weekends as a psych tech at the hospital. There were times when I would address a patient about some issue. And sometimes I would be met with opposition by the patient. And I would hear another patient say, “Hey, that’s Mike. He works at Amistad. He’s all right.” I saw that street cred (for lack of a better term) because I identified as a consumer.

My past is not my enemy today; my experience is my strength.

I had been sober for seven years and had been doing a lot of personal recovery work and had been a mental health worker, but was suffering from depression. Really, my recovery unfolded exactly as it needed to. A lot of my feelings of despondency unfolded as a residual effect from my trauma history. I’m a trauma survivor. I thought all trauma survivors felt the way I did. The physical pain and constant sadness were just part of my lot in life, I thought.

That sadness became entrenched and I couldn’t focus. I had a series of major suicide attempts. My plan was that I wanted to make it look like an accident. Fortunately, it did not work.

I was afforded the opportunity to stay in the hospital for fourteen days. The Bureau of Mental Health funded my stay there. When I got out of the hospital, the Bureau of Mental Health assisted me with paying rent. I started taking Paxil while I was in the hospital. I had a case manager that worked with me on re-entry into the community. More importantly, I had mental health peers who supported me after I got out of the hospital.

The SSRIs take about four to six weeks to reach their therapeutic level. After discharge, all I could do was take my meds, lie down on the couch and cry. I would go to support groups. Once a week, I would meet with my case manager. He was just the sweetest guy. My peers supported me. I went out in the community. I met other mental health consumers.

Not only did I have internalized stigma, but I had externalized stigma. These people who I had judged so harshly – they supported me and helped me. This is not how I saw myself as a provider. I thought I was a champion of mental health consumers and their right to recovery. I thought I was this dignified mental health worker who was non-judgmental – and here were my peers telling me I did pass judgment on them. They did it in a way that was empowering and very helpful to my overall well-being.

My own consumer-phobia was much like homophobia. I didn’t have to come out professionally until I took my job at Amistad. Coming out as consumer was just as bad as coming out as a gay man in 1991. “What would people think? Would I lose my job? What about my standing in the community?” I now know that it was stepping forward and claiming my space as a consumer that would give me strength (and support) to recover.

I would say that as a community, our diversity is our strength. We need to work together even if we don’t have a common goal. We have a common good that we can strive towards. We’re all fighting for a smaller piece of the same pie financially. Nothing creates more strife than money or the threat of cuts. I used to thrive working one-on-one or in small groups. Now, my job is macro, meeting with policymakers and meeting with the community. Sometimes when I hear the strife, I hear the passion and I’m like, “I’m right there with ya.” I see people reaching past that and they’re very courageous. Our diversity is our strength.

I Will Not Let My Suffering Be Wasted

Craig Lewis works as a peer mental health counselor in Boston. He also does public speaking about his recovery and life in the punk rock community. He is currently writing a recovery workbook called “Better Days.” He spoke with Kat Friedrich, CCSME’s social media and Internet marketing consultant, about the life experiences that motivated him to recover and write his book.

I’ve been dealing with mental health issues for a very long time and I’ve also been in the punk rock scene in Boston and around the world. I’ve been very active over the years. My community was not very supportive of me when I was struggling. I was certainly stigmatized and I did not realize I could manage myself better.

I was a person who – yes, I had a role in the punk world, had a fanzine, and was organizing shows and playing in bands – but it took me many years after I began my recovery to understand that those experiences kept me alive and taught me many of the skills I needed to be successful.

There was many times that I wanted to give up. Obstacles were tremendous. I had to just keep on course to try to make my life better. Ultimately, I’ve turned it into a wonderful turnaround for myself. I don’t want to see other people suffer as much as I did.

I grew up in a middle-to-upper class Jewish family. I was hospitalized for the first time in 1988. I was told I was psychotic and I was put into a residential treatment program for adolescents. I came from a fairly comfortable life and I was really forced into a community of people who had much less. At first, it was really difficult for me. But ultimately, they became my people. My family and myself became more estranged over the years.

I got into punk rock. The punk rock world just let me be sick and let me use drugs and be reckless. I lived in squalor for years and didn’t know about government benefits. My family kept me on a string. I lived in poverty, in homes with no electricity and with bugs. I was living with mostly dysfunctional people, which just resulted in more dysfunction for me. I lived that life of being chronically ill for years and decades, dealing with the police and drugs and getting in fights and living with people who were dangerous.

I was able to recognize that my community was very unsupportive to the degree of guiding me away from taking help or getting medication.

Punk rock was one of the only constants I had that kept me alive even though it was dreadful for me. The community has a lot of people who are self-medicating, living recklessly, and not taking care of themselves.

I come across a lot of people who want to write to me. I come across a lot of people in the punk scene who realize they have mental health issues. It’s hard to really step away from that life of partying and staying up all night.

I come across a lot of people who are facing being alienated from their peers. It’s quite a personal emotional conflict. How do you negotiate a relationship when you’re trying to move forward and the people you’re closest to are trying to hold you back?

I’m now viewed as a person who’s survived it all and is coming back to the community. I was very publicly ill. People know I come from that and I think I’m a bit of an authority on the topic – not that I like the word authority, but I’m an expert.

The most important thing that helped me begin my recovery is that I wanted it. I wanted to be well. The moment I heard the word recovery for the first time, I wanted it. I had lived my life saying to myself: there’s got to be something more. There’s got to be something better.

In those early days, I was facing dreadful obstacles. I really wanted to make my life better and nobody believed I could except for the people I met when I started getting services again.

I went out and got help from the Massachusetts Rehabilitation Commission. I started to meet people who were actively living with mental illness and managing substance issues and I wanted that. I wanted to be better. I took it by the horns and never let it go.

Now, I have really developed a life for myself out of the ashes of nothing. I have not stopped for a split second fighting for my recovery, my better life, and a better day.

Sunrise at Pulau Tidung

Lewis hopes to help other people who have faced adversity reach better days. (Source: stock.xchng)

I’m talking about my own story and how I ultimately got myself to be well. I work professionally as a peer mental health counselor and I’m respected by my clients. Most people who knew me knew I was in a very dark place. I was very ill and very dysfunctional. I’m really happy with who I’ve become.

That’s a story people want to hear. They benefit from hearing a remarkable story about coming from the worst of possible situations and turning things around.

Nobody helped me when I was living in hell for years on end. I was left to rot and I will not stand by and let other people go through what I went through. I will not let my suffering be wasted.

I’m grateful for everything that happened. I would not change a thing. I talk about some really terrible stuff when I present in different cities. I’m here for a reason and I survived all this and there must be some purpose for me.

And not only am I helping myself, I’m going beyond. I graduated with my associate’s degree in Human Services. I’m living a dream. I’ve gone from living in squalor and hell and ultimately here I am helping other people do the same thing. I love my life. That book is written [based] on personal experience. When a person reads that book, it’s like they are sitting there talking to me.

The book will help any person, whether they have a mental health issue or addictions issue, be able to identify what’s going on and make a decision.

The main message is: whatever goes on during your daily life, you have a choice to make. Regardless of mental health condition, addiction issues, past life history or current situation, we have the opportunity to [choose] how we address the stress and the crisis. Your life [can] become happier and healthier, with more stability, more wellness and more peace.

Craig Lewis’s website is www.punksinrecovery.com.

A Suicide Screening Tool for Everyone

Dr. Kelly Posner collaborated with a team of scientists to create the Columbia Suicide Severity Rating Scale (C-SSRS), a screening tool which a diverse range of communities in the United States have now adopted. She spoke at the Maine Suicide Prevention Program’s conference on March 21, 2013, “Taking Science into Practice: Beyond the Basics in Suicide Prevention.”

“This is one of our greatest public health epidemics,” Posner said. “It has surpassed car accidents as the number one cause of mortality [in the United States].” She cited shocking statistics about the growing frequency of suicide among African-American teenage girls, police officers, prisoners and the military.

Accurate screening can help prevent suicide. Posner said her team designed the C-SSRS to “fill a gaping hole in the field.” Pre-existing screening tools were inadequate and often did not cover the full range of suicidal behavior. They also led to false positive results because they included self-injury and thoughts about death.

Dr. Kelly Posner presents the C-SSRS

Dr. Posner presented suicide statistics and described how organizations use the C-SSRS to screen people from a variety of backgrounds.

One doesn’t need to be a mental health professional to use the C-SSRS, Posner said. She told the story of a grandmother at a Hindu temple in upstate New York who used the screening questions to save her grandson’s life. The local Hindu community had participated in a C-SSRS training.

For some audiences, Posner’s team adds specialized questions to the C-SSRS. Some of these questions are socioeconomic. Since suicide rates spike during periods of high unemployment, economic conditions make a difference. Posner’s team has also added questions about gang membership in some situations.

A diverse range of states and organizations have begun using the C-SSRS. These include Native American tribes, military organizations, correctional institutions, state governments and religious groups.

The conference was sponsored by the Maine Center for Disease Control and Prevention, Co-Occurring Collaborative Serving Maine, NAMI Maine, and Maine Primary Care Association.

Visit the link below to see a video of Posner describing the urgency of the suicide crisis.

Rating Scale Successfully Predicts Suicide Attempts

The Trevor Project Gives Hope to LGBT Youth

Teen suicide attempts are a serious problem in the LGBT community. Discrimination, threats, homelessness and violence can lead young people to take their lives. Athena Brewer, senior online programs manager at The Trevor Project, spoke at the Taking Science into Practice: Beyond the Basics in Suicide Prevention conference on March 21, 2013 about her organization’s heroic effort to save young people’s lives through social media.

Brewer’s presentation opened with some grim statistics. Compared to the general population, LGBT youth who are rejected by their families become 8.4 times more likely to commit suicide. Even LGBT youth whose families accept them become four times more likely to commit suicide. In contrast, young people who simply engage in same-sex experimentation but do not come out experience no change in their suicide risk.

Social rejection is one reason behind these disturbing numbers. Although only three percent of straight teenagers are homeless, around 25 percent of gay and lesbian teens lose their housing. Many of these young people are forced out of their homes because of their gender or orientation.

“We have a pandemic of homelessness,” Brewer said. “In all of our programs, we hear about youth who are being rejected by parents or being kicked out.”

Religion is sometimes a factor in families’ rejection of young people. “We do get a lot of people [whose] parents feel they’re going to hell and force them to conversion therapy,” Brewer said.

The Trevor Project currently serves over 3,000 young people each year and wants to expand its capacity. “Most of the youth we serve do come from the South and Midwest and rural areas,” Brewer said.Rainbow flag

In areas with little community support, where can LGBT youth go to seek answers? Often, their destination is the Internet, where volunteers from The Trevor Project are waiting to assist them. The organization offers a social website called Trevorspace.org, a phone line called The Trevor Lifeline, a chat site called Trevorchat, and an e-mail response line called Ask Trevor. Program staff are also developing a new texting service called Trevortext.

Volunteers provide a listening ear for youth who are coming out, helping them find their own answers to their questions. “We help them reflect on their thinking,” Brewer said. “We don’t label people; we don’t self-disclose.”

“We can expect them to talk about abuse,” Brewer said. On rare occasions, volunteers may intervene and call a local agency if a young person is being sexually assaulted or physically attacked.

Transgender youth are particularly likely to be isolated and in physical danger. Both trans men and trans women have started coming out during high school; this is the first generation where this is happening in the United States. It can be very dangerous to come out as transgender in an intolerant environment.

Brewer offers the following tips for counselors working with LGBT youth:

  • Don’t make assumptions about their identities or relationships
  • Don’t label them
  • Provide them with safe space
  • Don’t be an authority
  • Don’t use disrespectful or outdated terms about trans identity such as transvestite, transsexual, he/she, lady man, it, etc.

If you know any LGBT teens who may be at risk and live in the United States, you can refer them to The Trevor Project’s website or its 24/7 phone line: (866) 488-7386.

The conference was sponsored by the Maine Center for Disease Control and Prevention, Co-Occurring Collaborative Serving Maine, NAMI Maine, and Maine Primary Care Association.

The Invisible Wounds of Combat PTSD

What challenges do soldiers face when they develop PTSD and traumatic brain injuries? On March 21, 2013, Hahna David Patterson, director of psychological health at the Maine National Guard, described combat PTSD to an audience of mental health professionals at the Maine Suicide Prevention Program’s annual conference, “Taking Science into Practice: Beyond the Basics in Suicide Prevention.”

“More often than not, the wounds are invisible,” Patterson said. Many soldiers are reluctant to seek treatment.

However, seeking help may be exactly what soldiers need to do. Patterson said research shows social support helps people recover from PTSD.

“Most soldiers think they would get better going into a cemetery and swinging a dead cat than seeing one of you,” Patterson told the therapists and clinicians in the audience. He said soldiers tell themselves, “‘What’s talking to some nutcracker going to do for me anyway?’”

“Make sure it doesn’t sound like that therapy bullshit,” Patterson said. “They don’t like the word ‘trauma.’ They like ‘that shit that happened to you.’”

When soldiers do seek help for trauma-related conditions, they usually say they’re experiencing sleep problems, back pain, restlessness, digestive problems or exhaustion.

These physical symptoms occur because trauma gets locked in the body, Patterson explained. While service members are facing gunfire or explosions overseas, they do not process the trauma immediately. They are focused on survival.

“The body keeps the score,” Patterson said. “Combat PTSD has a delayed onset.”

A survey of service members showed 65 percent of the respondents were reluctant to ask for psychological help because others might see them as “weak.” Many respondents were also concerned their leaders or peers might treat them differently if they sought treatment.

Reluctance to seek help may contribute to the high levels of suicide among military personnel. Only half of the service members who need mental health treatment are seeking it, Patterson said.

Since the wars in Iraq and Afghanistan began, the military suicide rate has skyrocketed to around twice the civilian suicide rate, Patterson said. Before these wars, joining the military actually reduced people’s likelihood of committing suicide.

“We have had more suicides in the military than combat losses,” Patterson said.

Many of the military personnel who commit suicide have no observed history of mental health problems. Most of them do not talk about self-harm before committing suicide either. The triggers are often life events such as family conflicts, legal issues, career problems or financial challenges.

When soldiers return from tours of duty overseas, they lose their sense of having a mission and a community. This loss of meaning can make it very hard for them to reintegrate into civilian work and everyday life. “They miss the war,” Patterson said.

“No one returns from combat well-adjusted,” Patterson said. But, for most people, the stress of combat is subclinical. 18.5 percent of returning troops meet PTSD or depression criteria. 19.5 percent meet the criteria for traumatic brain injury, a condition which can reduce their cognitive and emotional capacity.

People whose childhoods were abusive are more likely than others to develop PTSD, Patterson said. Also, situations that are morally ambiguous or emotionally horrifying are relatively likely to trigger PTSD.

But there is good news for soldiers with PTSD. “It can and will get better,” Patterson said. PTSD symptoms tend to taper off during the first year after the event.

What solutions does Patterson recommend for suicide prevention? As an initial step, he says, each soldier who is at risk for suicide should turn in a gun to his or her psychotherapist. Most soldiers own multiple guns, but the act of turning in a weapon to a mental health care provider can show their commitment to seeking treatment rather than harming themselves.

“Having them give you their weapon creates a psychological shift,” Patterson said. He acknowledged this idea might be controversial among mental health care providers, though.

The conference was sponsored by the Maine Center for Disease Control and Prevention, Co-Occurring Collaborative Serving Maine, NAMI Maine, and Maine Primary Care Association.

Fixing My Mental and Physical Health

Jeff Irving, a former auto technician, is now starting a website called My Wellness Project. He plans to open a community center where people can teach one another self-care skills. He is also the president of Depression and Bipolar Support Alliance – Maine. He spoke with Kat Friedrich, CCSME’s social media and internet marketing consultant, about his life experiences. 

I was in the auto repair business for 18 years. In that career, I wound up in a severely depressed state of mind and ended up in the hospital and was diagnosed with bipolar II disorder. When I was diagnosed, I was told by all kinds of professionals: “You’ll never have a full time job again. You’re a person with a mental illness, you’re going to need medication and services, and the stress of running a business isn’t going to be very helpful.”

They convinced me to sell my business. I watched $100,000 disappear in four hours. It baffles me to this day, the advice you get from medical professionals when they don’t know your life history and what you’re capable of.


Citroen (Source: stock.xchng)

I hated the business. I was standing there in my shop with my door closed, thinking: “Why am I here?” My passion for it just died out with the job.

I entered the world of “I can’t” when I was diagnosed. I never grew up that way. I was always, “I can. I can do this if I want to.”

The medical model took away that aspect of me. When they started saying “depression” and “mania,” that got me off the trail. I don’t think I was depressed. I think I was full of “I can’t keep doing this.”

They had me on eight psychotropic medications. Five different visits to the most expensive hotel in the city, the psych ward. They kept saying the “I can’t” side of this. They kept saying, “You can’t do this alone.”

A nurse offered me pills in the hospital. I said, “I’m here because of those damn pills.” They said, “You’ll have withdrawal symptoms.” I said, “Look, I was a crack cocaine addict. I don’t think these little Clonopin pills are going to help me.”

If you won’t take any pills, they don’t want you in the hospital because you aren’t adhering to a treatment plan. I’m not a big fan of the treatment plan. They just want me to sign on the dotted line.

I don’t like people telling me what I should do. I did it cold turkey. It cleared my body up of all these toxins. I’d had these mood swings since I was a teenager. I’d never been psychotic. I’d never been depressed and laid around for a week. I’d had some life situations that were astronomical and unbearable to deal with. It was a gradual thing. One challenge landed in my world, and then another came behind it, and then a third one. I just lost faith in myself. I don’t think I was depressed in the clinical sense.

That whole process gave me the mindset that someone’s going to have the information that’s going to make it all right for me. It puts you in the mindset that someone out there is going to help you. But there’s no magic pill. All my problems are inside me.

That’s when I jumped back into my auto repair. There’s so much in relation to automobiles that it isn’t even funny.

I’m an auto repair guy. I can’t call the guy down the street and say, “How do you fix this thing?”

Cars are very much like human beings. It’s a challenge. Someone drops off a car and they can’t figure it out. The thing isn’t running right. What do you do about it? It requires a diagnostic process, asking the titleholder, and taking a lot of good notes before you look at the car.

I was in a specialty high-tech computer controlled shop and a lot of the cars that came to me were from shops where they didn’t have that equipment. I kept going from psychiatrist to psychiatrist, pill bottle to pill bottle, and therapist to therapist, and my car was running exactly the same way. That’s why I jumped back in the driver’s seat. I wasn’t a passenger on my path toward wellness.

Now, I’m on the other side of the coin from the medical-model world. I haven’t had any type of medications for over three years now. I think a lot of experiences in the medical-model world create a relationship of need. You need this service and you need these pills.

My medicine right now is food. I’m eating mostly all organic food. Back in my shop, if someone brought me a car with five gallons of kerosene in it – the car ain’t going to run right if you don’t put the right things in the gas tank. 75 percent of Americans are more toxic than the beef that people are eating. The stuff I’m eating out of the grocery store is chemicals.

That’s when I stopped having the excessive mood swings – when I stopped filling my body with all these toxins. It does cost me a little more, but only at the register. In the last two years, my prescription drugs cost $5.98. Probably 80 percent of what I eat is organic. My meat and animal product intake is 5-10 percent. I can’t remember the last time I had a hamburger. I eat mostly salads and fruits, raw stuff. I love bacon, but I don’t eat it five times a week. Maybe once a month.

bowl of salad

Salad (Source: stock.xchng)

I lost 60 pounds when I started. I couldn’t see my shoes. I watched a documentary called The Gerson Miracle which recommends a cure for cancer. It’s plant food-based, whole grains, starches. No milk, dairy, cheese, meat. Stay away from the processed stuff.

How can you expect your engine to run if you put crap in the gas tank?

There’s all kinds of services for crisis analysis. Why can’t we spend some money up at the top of the cliff? To me, that’s a proactive approach.

I’m constructing a webpage and am trying to open up a center here in town. My webpage is called “My Wellness Project.” There’s a ton of people out there who are obese and overweight who, with a few changes in direction, could lead a healthier life. That’s my journey right now: to open a wellness center here in town where the focus is on proactive wellness. Not reactive.


Motivating Recovery from Mental Health and Substance Abuse Problems

Richard Ryan

Professor Richard Ryan

How can people who are struggling with mental health and substance abuse difficulties build their motivation, curiosity, optimism, and visions for the future?

Two researchers at University of Rochester, Richard Ryan and Edward Deci, have said meeting people’s needs for competence, autonomy and relatedness increases their motivation to change their lives positively.

Their paper – “Self-Determination Theory and the Facilitation of Intrinsic Motivation, Social Development, and Well-Being” – says motivated people view their success as a result of their competence, the choices they make, and the close relationships they have.

According to Ryan and Deci, motivation flourishes naturally under constructive conditions. However, external circumstances can diminish people’s motivation. Outside pressures such as deadlines, material rewards, threats, imposed goals and critical evaluations can have this effect.

If people decide an outside expectation matches their own values and priorities and are in an encouraging environment, they may adopt that expectation as an internal motivator for action. For example, in school, children who have positive relationships with teachers who believe in their competence are more likely to succeed.

These insights also apply within the mental health system. Clinicians who have solid relationships with their clients, view them as competent, and encourage them to make independent choices are likely to find their clients are motivated to achieve their goals.