Measuring Progress:
Outcomes Valued by Service Recipients
and Steps Recommended to Achieve Them

A Report of the Recipient Advisory Committee
September 2006
New York State Office of Mental Health

Recent research has helped to enrich our understanding of what people who are served by the mental health system say helps and hinders recovery. A number of common characteristics associated with recovery have been identified. These include having basic material resources (e.g., a livable wage, safe and affordable housing, access to general health care, transportation, and technology); significant social relationships with family and friends, including intimate relationships; meaningful activities that help to connect people to their communities (e.g., educational advancement, substantive role in the work place, volunteer and other community advocacy roles); a self-determined life that is defined by the person rather than a diagnosis; and a belief in hope and the ability to change and grow.¹

As part of an effort to expand our growing understanding of recovery and to help develop indicators of progress for persons served within the public mental health system, the Commissioner's Recipient Advisory Committee met in the fall of 2006 to brainstorm what “life would look like if everything were successful.” The goal of the brainstorming session was to help the agency identify and track outcomes associated with healthy functioning, as a complement to the focus on measuring the short-term goals associated with services needed to achieve the longer-term outcomes.

The Recipient Advisory Committee is composed of recipients from all regions of the State. It meets quarterly, and invites participation at its meetings from interested recipients who might not necessarily be members of this advisory group. Approxi-mately 70 persons attended the September 19, 2006, meeting and contributed input into the picture of an ideal recovery. As a result of this meeting, the Committee has provided advice to the OMH Division of Planning and Division of Recipient Affairs on recovery outcomes for individuals with a psychiatric diagnosis. This paper provides an overview of information and recommendations provided.

Methods: Group Exercises

Led by John Allen, Director of Recipient Affairs, the brainstorming exercise involved eliciting responses to a series of questions about five major areas of functioning, based on characteristics associated with recovery. Divided into four groups, members considered the following two questions:

1. What would your life look like if everything was successful and you had everything you needed to recover?
1. What would you have?
2. Where would you live?
3. Who would you live with?
4. What would you do for transportation?
5. What would you do for recreation?
6. What would you do for employment?
2. What steps should be taken to reach the ideal?

Participants were asked to brainstorm, following usual brainstorming protocols, including the collection of as many ideas as possible from all participants without criticism or judgment as ideas are generated, and writing each idea on a flip chart so all participants could see them. Specifically, participants were asked to respond to the questions above within the discrete categories of a home, a car, a job, and friends and dates, all areas most anyone with or without a psychiatric diagnosis typically values. The following ideal definitions were provided to guide the brainstorming sessions:

• “Home” is housing to which an individual has tenancy or ownership and control over the domicile. While financial supports make tenancy or ownership possible, the individual maintains legal interest in the residence.
• “Car” is the means of reliable transportation. In rural areas, in particular, a “car” would translate into having a network of friends and supports who provide transportation assistance.
• “Job” represents a meaningful role in society. Such roles include having paid or volunteer employment, or assuming the role of parent, grandparent or spouse. A job presumes a measure of financial viability that enables individuals to afford simple comforts of life such as attending a movie or sharing a meal with friends.
• “Friends” are trusted persons outside of the mental health system from whom individuals receive and give mutual support and engage in regular recreational and social gatherings. “Dates,” on the other hand signify the establishment of a “circle of friends” and the means to having a relationship with a significant other. Dates lead to friendships, marriage or life partnerships that are defined by the ability to share the intimacies of life.

The groups spent time considering steps they could take to reach the ideal, “because they are tangible expressions of what we want to accomplish in the short term.” Two persons facilitated each brainstorming and problem-solving group and captured ideas for further consideration in planning and priority setting.

Results of Recipient Advisory Committee Deliberations

The results are presented in four categories: home, car, job, and friends/dates. Overall, participants noted that is was a “great idea” to consider these issues, but “tough to think outside the box.” Additionally, data from a summary presented by John Allen as well as a look at gaps in the current service system are noted following the synopses of the four categories.

Home

• Develop new laws to change the structure of how housing funds are allocated.
• Change independent supported housing rules and let families stay together.
• Provide legal advice on home ownership and on working with contractors.
• Scrap current housing programs and reroute funding into other programs such as rent-to-own properties.
• Provide funding to strengthen job skills to enable home ownership.
• Build private homes for persons with mental illness.
• Support a “Home of Your Own Program.”
• Help to move away from community residences into self-sufficient housing.
• Give the congregate care rate to recipients for use in applying toward home ownership.
• Promote State insurance and tax breaks to facilitate home ownership.
• Provide mechanisms to help persons with mental illness to have sufficient down payments to own their own homes.
• Promote low-interest loans for housing.
• Establish an “Office of the Cooperative,” a place peers could go to buy a house together and share the mortgage agreements.
•  Provide education on home ownership and independent living skills.
• Collaborate with nonprofit groups to renovate housing.
• Provide educational seminars to help people understand the responsibilities of home ownership, mortgages, and good credit.
• Help persons with mental illness to improve their credit scores.
• Provide education on Section 8, the Federal housing program that provides housing assistance in the form of rental subsidies to low-income renters and homeowners.
• Provide education and training by professionals on how to buy a home.
• Rely upon peer support to learn how to own a home.
• Tie housing subsidies directly to the person, not the system, thereby promoting choice.
• Promote tenant rights.
• Address issues of neighborhood appearance.
• Penalize landlords who do not maintain their properties.

Car

• Consider trading services for transportation.
• Develop a plan to set aside funding for the purchase of a car, for example, by allowing advertising on private vehicles as a way to support payment of a car.
• Provide access to half-fare cards for public transportation, insurance and gas.
• Develop a car pool database as a resource for times when rides are needed.
• Enter into partnerships with insurance companies to permit better group rates for recipients.
• Participate in roadside assistance plans.
• Promote advocacy to help recipients deal with the Department of Motor Vehicles.
• Increase participation in driver education programs to obtain lower insurance rates.
• Think innovatively, such as the development of a peer-owned fleet of cars.
• Ensure culturally competent driving instruction.
• Look to auto auctions as a way to procure affordable cars.
• Promote bus buddy programs.

Job

• Promote access to low-cost, affordable training.
• Encourage the use of the Social Security
• PASS Plan (Plan to Achieve Self-Support/Sufficiency) to help achieve work goals.
• Provide improved benefits and entitlement training for persons returning to work.
• Subsidize employers who hire and train persons with psychiatric disabilities and who help people with career development.
• Support for-profit businesses that assist with the startup of new businesses.
• Hire peers to work within agencies where they receive services.
• Set up internship opportunities in the community.
• Promote cooperative business ownership and participation, such as in food-buying clubs.
• Provide business model education.
• Train peers in community advocacy.
• Identify job opportunities outside of the mental health system.
• Help peers to identify work strengths through aptitude assessment and link them to internship opportunities.
• Foster self-assessment and person-centered planning to explore dreams and plan incremental steps to achieve them.
• Be assertive in working with VESID and take advantage of work-study opportunities.
• Promote the acquisition of skills necessary to obtain and keep employment, including interpersonal skills, resume writing, computer training, and dress for success.
• Deploy unused computers to help strengthen computer skills and look to community resources such as the Cornell Extension for training opportunities.

Friends and dates

• If you have a job, a home and a car, friends and dates will follow.
• Having access to others via the telephone is important.
• Utilize resources available through Hospitals Audiences, Inc., in New York City, which provides access to the arts for a number of individuals, including persons with disabilities, mental illness, and AIDS.
• Reaching out to existing groups in the community helps to build networks of friends.

Themes Cutting across Groups

One group noted that a number of concepts cut across the four categories of having a home, a job, a car, friends, and dates. These include:

• Not being afraid to take personal responsibility, initiative, and risks
• Having choices
• Networking to find people who might provide information and technical support in achieving personal goals
• Having an awareness of rights and resources
• Challenging stigma and discrimination
• Believing in possibilities and taking action to realize them
• Pooling resources and relying on resources outside of the mental health system; not seeing OMH as a sole resource
• Not being a victim

Other Themes Emerging from Group Discussions

In summarizing ideas to emerge from group discussions, Mr. Allen noted the following themes:

• Helping people to reclaim their dreams
• Desiring small business and entrepreneurial endeavors, such as developing peer car services, providing peer business support
• Sharing housing and creating differing housing opportunities, such as cooperative ownership and supportive mechanisms, such as bartering for services
• Developing support networks such as buying clubs, for example, to purchase insurance and other resources that help persons move toward independence
• Becoming educated about entitlements and benefits training as well as home ownership (e.g., how to purchase, how to contract)
• Supporting peer mentoring initiatives, such as the bus buddy program
• Helping to ensure the enforcement of rights, such as tenant rights, resolution of zoning issues, neighborhood beautification, safe neighborhoods
• Obtaining internships and volunteering in the community to gain job experience
• Addressing vocational training and education issues

Opportunities for Improvement

A short discussion of what is missing in the service system or areas for improvement led to the identification of the following issues:

• Detecting learning gaps for strengthening daily living and jobs skills development
• Having companionship through relationships and pets
• Turning community residences into transitional housing, not long-term housing
• Having ways (e.g., a web site) to exchange information on successes, effective training, cooperatives' stories
• Provide persons with mental illness settings in which they can be integrated back into the community, just as foster care support links children to family care
• Having the mental health system offer contracts to peer businesses and affirmative enterprises
• Changing the way we monitor progress (e.g., count “homes, not “beds”; count “careers,” not “jobs”)
• Looking to innovative recovery-oriented models of care, such as peer-run crisis support wellness recovery planning pioneered by Mead in Vermont, and peer-run crisis support in Ulster County promoted by Miccio
• Relying upon community supports, such as SCORE, which provides mentoring to persons wishing to operate their own businesses
• Assigning funds directly to the persons requiring services rather than to agencies
• Supporting recovery by maximizing choice, drawing upon personal strengths and tapping into faith and spirituality
• Ensuring adequate training, particularly in rural areas, where travel is an issue

Next Steps

The summary of the day's deliberations has been shared with the Bureau of Recipient Affairs, which will share it with the Recipient Advisory Committee. The summary will also be incorporated into the fabric of planning processes within the Office of Mental Health.

1. Onken SJ, Dumont JM, Ridgway P et al. (2002). Mental health recovery: What helps and what hinders. Alexandria, VA: National Technical Assistance Center for State Mental Health Planning, National Association of State Mental Health Program Directors. Available online at http://www.nasmhpd.org/generalfiles/publications/ntacpubs/reports/MHSIPReport.pdf