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Helping Oregon Community Mental Health Administrators Transform their Mental Health System

By Daniel Fisher, M.D., Ph.D. - June 26, 2008

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International Coalition takes flight
Celebrating Transformation in Oregon:
From left: Gina Nikkel, Executive Director, Association of Oregon Community Mental Health Programs (AOCMHP), Bob Nikkel, Oregon Commissioner of Mental Health, Dan Fisher, Executive Director, NEC, and Crucita White, Director of Consumer Outreach, AOCMHP

     I knew the invitation to speak in Boardman, Oregon was important to me. Why else would I have traveled a day each way to present a one-day seminar? Boardman, Oregon is a very small rural town three hours east of Portland nestled along the gorgeous Columbia River. It was the meeting place of the administrators from the 32 county mental health programs in Oregon. They have a good deal of influence over the course of policies in Oregon's county-based mental health system. In the five years since the New Freedom Commission was released, I have focused much of my attention on Oregon as a pilot for transformation because they have shown consistent interest in implementing a recovery approach. In fact, this visit represented my fourth address to the county administrators. The difference was that this time Gina Nikkel, their Director of Association of Oregon Community Mental Health Programs (AOCMHP), had gained enough trust by the directors that she was able to schedule a full day out of their 2 1⁄2 day meeting schedule.

      I was so impressed by the progress that that the group made that I will describe my agenda in some detail. I knew that it was important that they hear from voices besides my own during the day. So I invited four local emerging consumer leaders to participate. They were terrific. I met with them ahead of time, assuring them that their voice was important for administrators to hear. There were two young women from The Dalles, a small town down the river who run one of the only youth peer support groups that I know of. There also were two men from Fossil, a tiny town inland, who run a consumer warmline.

Agenda for June 26, 2008:

9-9:15 a.m.: Kimberly Lindsay, the host mental health director (and an administrator who understands the importance of peer support and recovery) introduced the Commissioner of the host county, Morrow County. Commissioner Terry Tallman made everyone feel very welcome and at ease with his folksy style, and willingness to talk about his own family. He also voiced positive support for community mental health and it is clear he and Kimberly have a positive working relationship.

9:15-10:30 a.m.: I presented my views of recovery through a focus on NEC's Empowerment Paradigm of Recovery and Development. I also introduced the importance of shifting to Person-centered planning, as a way to put the person's dreams at the start of the planning process, instead of the professional's focus on the person's deficits. I opened discussion on the question of what are the most important elements in causing mental illness, and its recovery. There was far reaching agreement that a psycho-socio-spiritual understanding of the problems and of the approach to assisting made the most sense.

10:45-noon: Panel of the four local consumers: the two young women led off with great energy and enthusiasm and told the essential elements of their recovery stories. They also told how important helping each other and others has been in their recovery. They kept their stories to 10 minutes each. Then the two men were very relieved to hear that they only had 5 minutes in which to tell their stories. Theirs also were very moving. They then did a 5-minute role-play of sample call to the warmline. The man who did the calling used the real life situation of the anxiety he had been feeling prior to coming to the meeting. They also commented on how important it has been to be able to support each other. They took questions afterwards and were excellent. One of the men pointed out that he has learned through working on the warmline that he does not have to solve peoples' problems but merely create the conditions where they can solve their own. They also encouraged other county directors to follow Kimberly's lead and establish warmlines in their counties.

Noon-1 p.m.: lunch

1-3 p.m.: I continued to discuss ways that these ideas could be implemented in the counties. I emphasized that there is a natural alliance between administrators and consumers. These are the two groups that often are the most open to change. The staff in the middle can be the challenge. Accordingly I urged them to make PACE recovery training materials available to staff of their mental health centers and residences, provide Finding Your Voice training for emerging consumer leaders, and follow the STEPs to recovery approach of involving consumers in peer support (S) , training (T), evaluation (E), and policy development (P).

3:15-4:30 p.m.: The conversation continued among the administrators and with the four consumers who stayed the whole day and were very active participants in all elements of the day. The directors came up with several important recommendations, which revealed that they clearly understood that consumers need to play a vital role in the transformation:

  1. A consumer-run conference would be held, where consumers tell the staff and legislators what works. Each county would put in some money and a director who would be the link from the counties to the consumers in a collaborative fashion. This dialogue-based conference would allow:
    • Consumers to connect with each other and share ideas and practices,
    • More staff to be exposed to these ideas about recovery and consumer-run activities through direct contact with consumers from across the state, and
    • Legislators to understand recovery from the point of view of the lived experiences of persons who have gone through their own recovery.

[The directors were so impressed by this idea that they agreed to start by contributing $1000 from each county, which equals $32,000]

  1. The County Directors want Gina Nikkel and Crucita White to facilitate the formation of a consumer advisory committee to the Community Mental Health Program Directors, who will dialogue with the directors and who also represent a significant number of consumers.
  2. The Directors agreed that their Association should work closely with the Oregon Consumer/Survivor Coalition (OCSC) on #s 1 and 3 above.

Lesson learned: Once again the success of this consultation depended first and foremost on my developing positive, trusting relationships with Gina, Kimberly, and several other administrators. It was important to bring in several prepared local consumers who spoke from their hearts. It was also significant that the atmosphere was relaxed and casual. Cowboy boots and blue jeans were the norm in dress and I quickly shed my coat and tie.

Follow up: Within four days, Gina Nikkel contacted a board member of the Oregon Consumer/Survivor Coalition. She explained the recommendation of the administrators to collaborate with the Oregon Coalition in conducting a consumer-run conference. The word spread quickly, and the Coalition members are very enthusiastic and want to make it happen. This outreach by the Oregon Administrators is an important step in building trust between them and the consumer/survivors of the state. This plan of collaboration is able to happen because the Oregon consumer/survivors have come together in a statewide organization.