This is the second of two columns focusing on supported education as an important strategy in transforming mental health services. The column in the May issue described an ongoing program at META services in Phoenix. This issue's column describes a supported education initiative at Boston University.
The journey of recovering and healing from the devastating effects of a mental illness is multifaceted and unique for each person. Education is a tremendously effective vehicle that can provide fuel for the travel over an often winding and slippery road to recovery. Based on our early initiatives in supported education on the Boston University campus,1,2 the university's Recovery Center has been using education as a tool and the campus as a site to assist people with recovering from serious mental illnesses.
The Recovery Center's adult education program focuses on critical interconnectedness of mind, body, spirit, valued roles, and community. This educational approach to recovery is oriented toward health, growth, and ability, and is similar to a rehabilitation approach3 designed to improve the quality of life of individuals through skill and support development.
The power of education as a paradigm for recovery-oriented service delivery is that it immediately gives consumers a valued role. Who wouldn't want to be a student instead of a patient or mental health consumer? As one student at the Recovery Center stated:
The first thing the educational program provides me with is a sense of pride. Pride that comes from being in a program that is organized like a college semester instead of a program where you stagnate and wallow in your problems. When I get up in the morning, I feel as if I can face the day. I feel wonderful because I don't have to attend groups where trauma and sadness drift from patient to patient: The program has been invaluable to me, it is providing me with more hope than I have achieved from any group therapy.
The prejudice and discrimination associated with labels of illness and disability deplete hope and decrease expectations for both providers and the people they help. Services that offer recovery education provide their participants with the opportunity to engage in mutual relationships in which the expectation is “the best teacher is always learning,” and people with mental illnesses are viewed as the experts in their particular life experiences. As another student at the Recovery Center reflected:
To me, the most powerful force at the center is the level of respect between the students and the staff and [among] the students. My input has been seen as valuable, and I have not once been humored. Nor has any student in my experience. There is not an ounce of condescension.
This mutuality might seem strange to some mental health professionals, who often are trained to experience people with serious mental illness as having significant deficits, thereby rendering them incapable of becoming contributing students. Yet education as a framework for the provision of recovery services allows the development of relationships that are based in mutuality, hope, and respect. A quote from a student illustrates the power of providers as educators and inviting consumers to be students in their recovery:
The Recovery Center staff are warriors compassionately helping us fight for the life, freedom, and victory of our spirits. The staff seem to have developed great skill in posing challenges in clear and simple terms. They have a commitment to being educators and facilitators, of “getting out of the way” so that the spotlight stays on our values and our empowerment.
The admission criteria are straightforward. People must have a psychiatric diagnosis and be willing to be in an educational environment. While on campus, students are expected to not use illicit substances and to be safe. Participants do not have to be current students of Boston University.
The Recovery Center offers educational coursework that broadens and strengthens people's knowledge of their physical, intellectual, emotional, social, and spiritual practices. The courses aim to teach knowledge, skills, and support strategies, as well as raise awareness of their ability to recover. Classes purposively are designed to engage people at all stages of recovery and all phases of change.4 To this end, students are invited to enroll in one to four courses a semester.
Examples of some of the classes in the Recovery Center include:
Sexual Intimacy and Connections
Communication and Friendships
Successful Student Skills
Time and Money Management
Introduction to Computers
Employment Success and Satisfaction
Surviving Social Security
The Meaning of My Spirituality
Wellness Recovery Action Planning
Ideas for courses come from multiple perspectives: student needs expressed at a monthly student advisory board meeting, the research literature, and past delivery of educational services in vocational, educational, and physical recovery. The monthly feedback from the student advisory board allows for relevant and authentic program development that actually meets students’ needs.
Funding for the program comes from private donors and foundations to provide scholarships to the participants.
The development and choice of staff for the Recovery Center also draws upon the adult education model and the peer support model. The Recovery Center employs 26 staff members, most of whom are part time and teach courses in an area of expertise. More than two-thirds of the staff are people who have had psychiatric experiences themselves. This staffing pattern provides a level of validation to the students that they often have not experienced in other mental health programs.
Students have opportunities to gain experience and become facilitators in the Recovery Center. Courses such as Leadership Training and Peer Advising help prepare the students to teach and, if they desire, students can “intern” with a more experienced facilitator over a semester. Integrating peer employees into the Recovery Center has multiple benefits to the organization, the nonpeer staff, and most importantly to the students. A student who has become an instructor speaks to this benefit:
What can I say about the staff? Humanity. They have one thing in common, and that's humanity. Even though everyone has different roles and experience, the staff are all committed to promoting a healthy environment where people are not statistics—where people are people and not patients.
Students have the responsibility to be students, not patients or consumers, and to communicate what works and what doesn't work at the Recovery Center. It is a mutual process of give and take on an organizational and personal level that works because it starts with the premise that everyone can learn, grow, and recover. It is best described by a student:
Dori Hutchinson, ScD, is Director of Services of the Center for Psychiatric Rehabilitation at Boston University.
When I came to the Recovery Center, I was hoping—all I had was hope. I came here and found people who are sensitive to my feelings. I found people who tell me what I feel has meaning and is real. I feel like I am in an atmosphere where I can trust to communicate these feelings. I am living in the world of mental illness, and the people at the center are looking into that world. The Recovery Center has been a catalyst in helping me communicate, live, and trust in the world again. To me, living life has been a torment, and the Recovery Center has given me hope that I can make the next step in life that has a bit of comfort and caring.
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.
- Anthony WA, Unger KV. Supported education: An additional program resource for young adults with long term mental illness. Community Ment Health J 1991; 27:145-56.
- Unger KV, Anthony WA, Sciarappa K, Rogers ES. A supported education program for young adults with long-term mental illness. Hospital and Community Psychiatry 1991; 42:838-42.
- Hutchinson DS, Kohn L, Unger KV. A university-based psychiatric rehabilitation program for young adults: Boston University. In: Farkas MD, Anthony WA, eds. Psychiatric Rehabilitation Programs: Putting Theory into Practice. Baltimore Johns Hopkins University Press; 1989:147-57.
- Prochaska J, DiClemente C. Stages of change in modification of problem behaviors. In: Hersen M, Eisler RM, Miller PM (eds.). Progress in Behavior Modification. Sycamore Ill.:Sycamore Press; 1992:184-214.
Staff of the Recovery Center have provided technical assistance to staff from universities, community mental health centers, and other mental health organizations in replicating parts of the Recovery Center. Interested readers who wish detailed information about the Recovery Center should contact Dori Hutchinson or Cheryl Gagne through www.bu.edu/cpr.