Until the development of the supported education concept (which helps people with psychiatric disabilities choose and achieve educational goals),1 educational interventions and educational outcomes for people with severe mental illnesses rarely had been considered. It has been implemented in a variety of locations (such as California, Illinois, Massachusetts, and Michigan) during the past two decades.2 In the first nationwide survey of members of the organization now known as the National Alliance on Mental Illness, members reported that while only 5% of their relatives with mental illnesses were working full time, 92% had graduated from high school, 59% had attended college, and 17% had graduated from college.3 Depending on the particular sample taken, 52 to 92% of people with severe mental illnesses are high school graduates, and 15 to 60% of these high school graduates attend college.4 Unfortunately, mental health interventions rarely capitalize on people's interest and success in education.Because we believe strongly that any successful system transformation must include educational interventions, this column and the next will feature two different Recovery Education Centers (RECs) developed simultaneously 2,000 miles apart that share information with one another. Interested readers can choose from various components of these two different recovery education initiatives to develop their own unique recovery education efforts. In this issue, we examine the Phoenix Recovery Education Center.
The Phoenix center's development was a learn-as-you-go process. We began in 2000 with a vision of a place where people could learn how to recover, work, and build social supports. Instead of a one-size-fits-all approach, we envisioned a place that values originality and offers many choices and individualized approaches to the recovery process. We hoped to create a place that could begin to close the gap between people who receive services, providers, and family members by developing a setting where they could take classes together on an equal playing field and learn from each other.
We tried to think of existing models that might serve as a foundation on which to build our vision. We wanted to offer a recovery-oriented behavioral health program that counted on the energy and enthusiasm we know people with serious mental illness have but that often goes untapped. We had memories of being in uninspiring day treatment settings with a strong focus on illness and largely staff-driven. Drop-in centers were more like drop-out centers, with no focus on recovery. The club house model came to mind, but the ones we knew were geared for slow growth; we wanted to create an environment of high expectations and open-ended opportunities to allow people to reach beyond what they had been led to expect of themselves and us.
Overall, it seemed that existing models had been built on a foundation of illness—not recovery. We needed to develop an environment that could support our vision. We wanted to support the person, not his illness, and we knew that if the person could grow bigger than the illness, he would be well on his way to recovery. The illness still would be there, but the person could begin to live his life as a victor instead of a victim. We realized that we may not be able to cure the illness, but we could minimize it and help the person heal wounds and move ahead with his life plans.
Since we wanted to engage people in ways that promoted personal responsibility and self-direction, we chose a foundation based on behavioral health education. We didn't want to perpetuate the myth that we could fix them; we wanted them to learn how to fix themselves. This would allow people to try out the role of “student” as opposed to “patient” and invite them to learn about recovery instead of mental illnesses.
When we opened the REC's doors in 2000, we found that most people coming in for services had no educational goals and had never thought of themselves as “students.” Many had negative experiences in schools, leaving them with more of a sense of failure than of achievement or validation.
The REC is licensed as a Private Post-Secondary Educational Institution by the state of Arizona and, through an agreement with South Mountain Community College, offers credit for most classes and even an associate's degree in behavioral health recovery. Our students are amazed that they can earn college credit for taking Peer Employment Training (a 70-hour class that trains people receiving behavioral health services how to use their personal experience to help others recover), since it values and builds on what they already have learned through painful experiences. Once they take this class, or any other class, and see that they can succeed, they usually become very enthusiastic about continuing to learn recovery and personal growth skills.
The REC has approximately 300 students at any time. Some are hoping to earn a college degree. Some are taking one class at a time. We've found that most of our students have lost many opportunities because of the consequences of mental illness. Education is one of the most grieved losses, since without it most people are stuck in low-paying dead-end jobs that often contribute to low self-esteem and perpetuate an illness identity. We make it as easy as possible to get started: People simply can check out the list of classes, call our education coordinator for an appointment, and make plans that will enhance their life goals. They can audit classes or enroll for credit or noncredit and, in most cases, withdraw from classes with no penalty. The classes are paid for through funds from META Services, Inc., the city of Phoenix, state government, federal government, and the community college.
Our instructors meet the community college's standards, and most of them are people or family members of those with a mental illness, leading to a great sense of camaraderie between faculty and students that supports the learning process. For example, Ellen Dayan developed and teaches a class called Beyond the Border, which discusses issues associated with the diagnosis of borderline personality disorder—Ellen's diagnosis. At the close of one session, a student gently pressed a razor blade in Ellen's hand and said, “If you don't need this anymore, neither do I.” The entire class stood and applauded her. A psychiatric nurse in one of Ellen's classes said, “I've learned more about people with serious mental illnesses here than I did in all of my formal education. I see you as people now. I realize that people can recover.”
REC faculty and staff work closely with case managers in our local clinics to coordinate learning plans with each person's individual service plan. Some students have been away from a classroom for a long time and benefit from enrolling in one of several classes designed for a smooth reentry (e.g., Becoming a Successful Student). These classes are intended to inspire interest and self-confidence in learning. Some students want to find work quickly and register for classes such as Communication Skills, Introduction to Human Relations, or Recovery Through Employment. Other students want to learn more about recovery and enroll in classes such as Recovery Pathways, Recovery From Grief and Loss, or Mental Health for Women.
Our students often go on to do great things. One student started her own advocacy business for parents diagnosed with serious mental illnesses struggling to have their rights respected by child protective services. Another student recently was promoted to team leader of a local outpatient program. Several students have enrolled in two- and four-year colleges to pursue studies in behavioral health and other areas. The great thing about watching our students move on is knowing that they have taken advantage of the opportunity to grow and learn here, and that what they take with them is an abiding confidence, hope, and sense of personal mission.
It's an honor to be part of their growth and learning experience and to watch them find ways of living beyond illness.Lori Ashcraft, PhD, directs the Recovery Education Center at META Services, Inc., in Phoenix.
William A. Anthony, PhD, is Director of the Center for Psychiatric Rehabilitation at Boston University.
Ellen Dayan is a Recovery Services Instructor at the META Services Recovery Education Center.
- Unger KV, Anthony WA. Are families satisfied with services to young adult chronic patients? A recent survey and a proposed alternative. In: Pepper B, Ryglewicz H, eds. Advances in Treating the Young Adult Chronic Patient. (New Directions for Mental Health Services, no. 21). San Francisco:Jossey-Bass; 1984:91-7.
- Mowbray C, Brown KS, Sullivan-Soydan A, Furlong-Normal K. Supported Education and Psychiatric Rehabilitation: Models and Methods Columbia Md.:International Association of Psychosocial Rehabilitation Services; 2002.
- Spaniol LJ, Zipple AM. Family and professional perceptions of family needs and coping strengths. Rehabil Psychol 1988; 33:37-45.
- Anthony WA, Cohen MR, Farkas M, Gagne CA. Psychiatric Rehabilitation 2nd ed. Boston:Center for Psychiatric Rehabilitation; 2002.