Personal Accounts: Transformation: Recovering Mental Health Treasures

What about their strengths? As I reviewed the charts, I could not find much, if any, information about strengths. Did our clients not have any strengths? Did they leave all their strengths in the institution? This became a challenge. I was determined to find the strengths of each of my clients. Because I could not find any clues in the chart, I spent most of our individual sessions searching for strengths; it became my treasure hunt.

The clients were a little confused and defensive. They were more comfortable talking about their current symptoms of hearing voices, their history of hearing voices, and their hospitalizations. It took a while, but they finally realized that I was on the level; I really wanted to learn more about their strengths, talents, and hobbies. These strengths really were treasures. It took some trust for them to reveal this part of their lives, a part not touched in years, like a buried treasure. I handled those strengths with care, like a fragile heirloom. During this search, I began noticing that each client had traits of resilience. Even though they had each been through many crisis events, job losses, and family problems, they always seemed to bounce back.

Where there is strength, there is potential. Instead of seeing my caseload as a bunch of patients with chronic mental illness whose main goal was to stay out of the hospital, I began seeing them as people who could live a more independent life. “Rick” had been on my caseload for a few years. One of his treasures was a talent for golf. He had been a golf champion on his high school team. He loved talking about his past experiences on the team, and I loved listening to him talk because he seemed to come alive as he shared his story. I really went outside the therapeutic box one day and asked him if he wanted to drive some golf balls instead of meeting for therapy (I had requested and received permission from my boss beforehand).

Something was happening. I was relating to Rick and other clients through their strengths instead of their illnesses. Was I doing something wrong, violating some kind of sacred boundary? I was seeing them not as sick patients, but as people with an illness. Note the word “people” coming before “illness.” This was revolutionary for me.

“Ron” was transferred to my caseload. He recently had been discharged from the state hospital after being there for 30 years. The dynamics of “de” and “in” at our clinic were real, and Ron was evidence personified. Because Ron had been locked up for 30 years, he was used to being in a clinic all day. He would arrive before we opened and stay until we closed, even though he had no appointment. Ron would sit in the waiting room every day, staring at nothing. I guess this is what he did in the state hospital. I did not know how to help him.

There was a small kitchen across the hall from the waiting room. One day I asked Ron if he would like to sell coffee to the other patients. He said yes, and we were off to the races. We charged 10 cents a cup. Coffee started selling like wildfire. We soon added Cokes to the inventory. I asked another patient from my caseload if he would like to work in the kitchen. This was not an official program and was not covered in the Policy and Procedure Manual. We called it the “Country Store,” as our product line expanded to chips, candy, and sandwiches. Eventually there were about four clients working the store, two on each shift.

Other caseworkers began asking me if I could find something for their clients to do. Within about a year, we had eight to 12 clients doing clerical duties and four working the store. I noticed that other staff members were relating to these clients differently. We all were. They were working and fulfilling responsibilities, and we were relating to them through their strengths.

I also learned about the therapeutic value of responsibility. Responsibility can be as valuable and powerful as medication. As clients would volunteer for jobs, I would assign tasks. Through trial and error, I learned that responsibility needs to be titrated like medication. Too much responsibility often resulted in an increase in symptoms. This required me to closely monitor stress and coping mechanisms, adjusting responsibility up or down before the stress and symptoms escalated to the crisis level. By pushing clients a little past their comfort zone, they developed greater self-confidence.

I stayed at MHMRA for 14 years. During that time, a transformation occurred both in the field and in me. When my professional transformation started back in the 1970s, the word “recovery” was not part of the mental health vocabulary. Only in the past ten years has the concept of recovery entered into mainstream mental health. As I read current articles on recovery, I can look back at my transformation experiences and see basic recovery principles at work. I started the job not knowing much and left with a strengths-based focus. I had some good teachers—H. Steven Moffic, M.D., and Rose Childs, M.S.W.—but mostly, my teachers were the consumers themselves.

What did I do with the rest of my life, after leaving the “mother ship” (MHMRA)? I worked for six years at the Mental Health Association of Greater Houston as director of public policy, although I did not direct much—just dabbled. I then became the executive director (ED) of the Gathering Place, a clubhouse program. I learned a lot about being an “ED”—mainly that I did not want to be an ED again. But, while there, I did start another Country Store. I stayed seven years and then went back to the mother ship.

I have been at MHMRA for five years now, as the coordinator of the Consumer Advisory Council (CAC). I found some of my own treasures along the way and still discover more among the consumers who work on the CAC. Guess who my boss is? Ms. Childs, except now she is the deputy director of an agency with 1,600 employees.

The mental health literature I read today shows a balance between managing symptoms and promoting recovery. Focusing on and encouraging strengths development is a step toward recovery; how far we have come since 1977.

If we agree that mental illness affects a person's self-esteem and self-confidence, then what can we do to encourage self-confidence? Many of the clients I work with do not recognize their strengths and have little confidence in their abilities. The treasure hunt approach not only helps clients discover sometimes long lost or unused strengths but also encourages them to believe in themselves.

A strengths-based focus is more common today than it was 25 years ago. However, managed care and state budgets tend to focus on efficiencies and third-party billing. Is it possible to have a recovery-focused system and generate a sufficient amount of revenue to balance the budget? Can we give equal weight to both? Constantly giving more weight to revenue efficiencies can have unintended consequences. If recovery values are not a priority, we can unintentionally increase the cost of providing mental health services. As more consumers improve in their recovery, they will use fewer and less costly services. To transform a community mental health system toward a balance of recovery and cost-effectiveness priorities is a major undertaking, a tiny bit more complicated than transforming one mental health care worker's perspective. It has been an exciting journey, from lobotomy to recovery, with many treasures discovered along the way.

Mr. Bateman expresses his gratitude to H. Steven Moffic, M.D., for being a role model and teacher to him throughout his career and for providing encouragement to write this column.