By Michael Szczerbaty, M.A., MHSC
There are two CPRs I would like to tell you about. As many of you know, LAC DMH has a unit under the Program Support Bureau called Client Peer Relations (CPR). CPR was responsible for the recent "Hope and Recovery" conferences for diverse audiences, which were very successful. CPR is also responsible for training PADS (Peer Advocate Development Seminar) and PAL (Peer Advocate Leadership Council) participants.
As the CPR brochure states, "CPR was established as a change agent for recovery-focused services and to provide peer support to people with lived experiences of psychiatric disabilities who receive services from or work in the public mental health system of L.A. County. Founded as an advocacy group within DMH, the Office of Client-Peer Relations (CPR) is dedicated to the inclusion of mental health clients as valued members of our community, and of their peers who work in the system as valued members of our work force. As part of the Program Support Bureau, CPR carries the message of hope, wellness and recovery to all clients and staff of the Los Angeles County Department of Mental Health and, whenever possible, to the larger community that we serve."
At the 25th annual 2011 Alternatives Conference I recently attended in Orlando, Florida, I learned about another CPR known as Emotional CPR (eCPR). "The three components of eCPR, are: C = connecting, P = emPowering, and R = revitalizing. eCPR was developed to address the vast and compelling need to teach both lay people and mental health providers how to assist individuals through an emotional crisis." 1
The following summary is a collaborative effort between myself and Lauren Spiro, a lead eCPR trainer. Lauren works with Dr. Daniel Fisher, of the National Empowerment Center in Massachusetts. Dr. Fisher was once diagnosed with schizophrenia and was also hospitalized on several occasions. After he recovered, he became a 'psychiatric survivor' who went on to complete medical school and eventually became a board certified psychiatrist. Dr. Fisher was also at the Alternatives Conference as speaker for eCPR, and believes eCPR should be taught internationally to anyone within mental health who is looking for a way to effectively help those individuals who are in crises.
Emotional crisis is a "universal experience" — it can happen to any one of our clients, at any time. "When a client is exposed to extraordinary circumstances, he or she develops creative ways to protect themselves from real and/or perceived harm." 2 Through the use of eCPR, a client can better understand their unusual behavior that was brought on by an emotional crisis. Supporting people in resuming meaningful roles, relationships, and routines within the community is the goal of eCPR.
The approach is said to be “holistic, hopeful, and empowering." 3 It is a heart-to-heart experience between provider and client. It is embedded in a hopeful belief of the provider that by using their interior experience and knowledge, they can help a client recover from an emotional crisis. Rather than labeling someone with another 'mental health problem,' the approach assumes that the person is coping with an experience beyond their current ability to effectively manage their emotional crises. The sooner an eCPR practitioner begins to support a person in their emotional crisis, the more likely it is that “the person will make a full and timely return to a life that has meaning and purpose for them.”
Some clients respond to severe emotional distress by "retreating into 'monologue:' an isolated and disconnected emotional state." 4 In monologue, a person's rational ability to think clearly gets interrupted and their sense of self is submerged and no longer available for engaging in a dialogue with anyone else. "eCPR teaches support skills for the client to stay centered and provide a safe space for the client in crisis to express his or her strong emotions — all the while both persons are able to experience their own vulnerability." In this way, eCPR practitioners assist a person to go from ‘monologue’ into dialogue with others. This "emotional dialogue" allows the participant to understand the deeper meaning behind the feelings. From this shared understanding, helpful insights occur that allow a client to move beyond crisis, and to develop a more hopeful approach to life.
The reestablishment of dialogue is accomplished through the three phases of eCPR:
1. Connecting: begins with the provider being fully present for the client, listening with their full attention on an emotional level which creates an emotionally safe relationship, cultivates hope for the client, validates the client, and communicates a sense of compassionate caring by the provider.
2. EmPowering: Feeling that connection, the client in distress begins to experience their power, and their ability to plan their next steps. This occurs when the assisting provider enters into a collaborative "power with" as opposed to "power over" relationship, which enables the connecting and empowering to be reciprocal.
3. Revitalizing: Experiencing connection and power and the ability to plan next steps, the client's vital center becomes engaged, clearer and stronger. They are ready to re-establish or resume social roles, responsibilities, and relationships.
"The heart is a 'sense' that the provider uses to detect the voice of another's heart." When we are tuned in to the sound of our own heart, it's easier to make that "heart-to-heart" connection that is at the foundation of eCPR. "One man said that when he was in distress, his heart stopped talking to him and his thoughts became confused. When friends listened deeply, connecting at the heart level, he began to be able to hear the voice of his own heart and his thoughts became clear again." 5 This eloquent description illustrates the sense of emotional "numbing" often reported by clients in crisis. Listening with the heart is a skill provider's gain when they have learned to be present. This is similar to "Mindfulness training."
eCPR teaches providers what to do if they encounter a client in emotional crisis. "It demystifies the process of supporting someone and it also teaches skills that enhance communication and better understanding in all relationships." 6
In the caucus it was also stated by Dr. Daniel Fisher that even non-professionals, such as Peer Advocates certified in eCPR can help clients recover from severe emotional distress and trauma, thus preventing the unnecessary use of costly hospital emergency rooms.
"When clients feel that they have a meaningful and valued place in the community, they are less likely to "act out" and hurt themselves or others. Thus, eCPR helps build stronger and more resilient communities." 7
"The International Association of Chiefs of Police has recommended including eCPR in law enforcement training." 8
I believe that the two CPRs — the Client Peer Relations (CPR) Unit, and Emotional CPR (eCPR) — could complement each other very well and improve outcomes for clients living within Los Angeles County. After certifying a sufficient number of providers in eCPR, the department could form an eCPR outreach team to connect with people in the community who are reported by family and/or police to be in crises — perhaps to the point of wanting to hurt themselves or others. Instead of 5150(ing) the individual in order to take them to the hospital, in most cases the individual in crisis could be assisted at their place of residence by the eCPR outreach team. Similarly, those clients who 'walk in' to the clinic in crisis could be treated by a certified eCPR specialist. Just like physical CPR can save the lives of people experiencing cardiac arrest, eCPR can also save lives of people in emotional crisis. eCPR not only can prevent costly and unnecessary hospitalization; it can also provide hope and needed resources for clients’ integration into community life.
After what I experienced and heard at the eCPR workshop and caucus at the 2011 Alternatives Conference, it is my hope, (as one who has lived experience and is in fact, a psychiatric survivor) that LAC DMH will explore the possibility of providing eCPR Certification training in 2012. I think a double dose of CPR would go a long way to help our clients feel better, and put more of them on the road to Recovery.
For those interested in further information on eCPR, please go to: www.emotional-cpr.org.
In addition, for those interested in the "...groundbreaking real-time social media coverage featuring in-depth recaps of the premier national consumer conference” 9 that transpired at the 25th annual 2011 Alternatives Conference located in Orlando, Florida, please go to: http://www.peersnet.org/alternatives2011. The theme of this conference was "Creating Our Own Communities of Wellness and Recovery."
1. Taken from my notes during the eCPR workshop at the 2011 Alternatives Conference. (Notes)
5. Added by Lauren Spiro.
7. Dr. Daniel Fisher speaking at the 2011 Alternatives Conference workshop.
9. Taken from Peers Envisioning and Engaging in Recovery Services (P.E.E.R.S) on their website http://www.peersnet.org/alternatives2011
As someone who has experienced many years of trauma, I decided to attend the “We Can Heal from Our Trauma” workshop on Thursday afternoon at Alternatives 2011 Conference. Honestly, a part of me was somewhat reluctant, scared and filled with fear about possibly being triggered and going down a not-so-pleasant memory lane. Also, I was not sure what to expect when I walked into the Bocca VII room for this workshop. All I did know, based on the description in the conference’s program, was that the workshop facilitators identified themselves as consumers who have overcame and healed from their own traumatic experiences.
Needless to say, despite my ongoing yearning desire to continue to grow into a stronger, wiser and greater person, I cautiously sat in the back of the room as a defense mechanism. But at some point in the early part of the workshop, I made a conscious effort to have an open mind and interested heart, so my healing could occur despite my sensitivity to distressing issues that cause deep pain. Then before I knew it, I was captivated and awestruck by presenter Sharon Wise’s eloquent and charismatic speaking ability.
Sharon Wise has been hospitalized and imprisoned over 30 times, often by force. She discussed in length about being secluded and restrained while institutionalized, Sharon also shared her experience of abuse, drug addiction, mental health challenges, as well as the pain she endured after giving her only daughter up for adoption.
As a result, Sharon was able to boldly and graciously share all that she learned from her experience and how she got through her suffering. Sharon taught those who attended the workshop, the powerful healing tool of the arts (music, dancing, drawing, film making). Sharon herself is an outstanding artist who creates vibrant, colorful self-portraits that illustrate her traumatic experiences and African-American heritage. Through Sharon’s facilitating of the workshop, she clearly and effectively communicated her strength and hope. She uplifted, inspired and reiterated my own belief that all things are possible. I honestly can say that Sharon comforted and filled my mind, soul and spirit with more aspiration. Her presence alone was warm and peaceful.
Sharon’s son DJ Swagg, boldly and good-naturedly, spoke about his experience being raised by her while she was dealing with personal struggles. He discussed his pain of witnessing all his mother had gone through, and how much he still loves and respects her. Her son also shared how he looked for his sister that was adopted, found her on Facebook and reunited their family together.
The order and process of this workshop was extremely moving. At the end of the workshop, I tearfully expressed to Sharon and everyone else in the room, “This workshop made my Alternatives.”
I truly believe that Sharon Wise is an excellent motivational speaker. Her son being included in the workshop’s course of action made it even more of an amazing process for me. I look forward to next year’s Alternatives Conference, and I hope to attend more workshops facilitated by Sharon Wise. I know her story would benefit others. So I nominate and advocate for Sharon Wise to be a keynote speaker at Alternatives 2012 Conference!
This morning, Janice Sorensen and Andy Grant of Western Mass Recovery Learning Community presented their workshop, "The Artist First Approach to Peer Work in Mental Health Recovery: Finding, Engaging and Connecting The Artists in Our Communities." They discussed how they created an opportunity for peers to share their stories and express themselves through art, which each artist exhibited in their own show.
At the beginning of the workshop, each attendee stated what type of art they participate in and how it makes them feel. Repeatedly, participants mentioned that they could get lost in their art, taking a moment away from the stress and difficulties of life. Although the presentation focused on visual art, the art that I get lost in is dance. I have danced ever since I can remember and truly started taking ballet seriously at age 10. For me, dance has always been a time away from the stresses of life, a place to fully express myself, and a source of my nearest and dearest friends. Although ballet is strict in its rules and discipline, there is a freedom to interpret the music and movement and express your inner-most feelings.
I particularly love dancing on a sunny Sunday afternoon when I have no cares in the world. I can let my light heart leap and soar. But, when I have been having a bad day or a bad week, nothing can lift my spirits more than dance. I can go to the studio, stand at the barre, and know that the movements I am creating and perfecting are purely mine. All dancers know how to plie and pirouette, but nobody's looks exactly like mine. No body puts the same exact experience and feeling behind them. I can get lost in the intricacies of the movements and combinations; I can truly let my mind go. When I am dancing I don't have the opportunity to think about the laundry that needs to be done or the dishes that need cleaning. I only have the time to think about the position of my arms, whether my feet are pointed, and if I am balanced perfectly on my leg. It's a time when I am the center of my attention, and no one or nothing else is.
I truly believe that anything you are passionate about and allow yourself to become lost in — whether it be photography, water colors, collage, or dance — can help you to become a more expressive, happy, and content person. I've been lucky to find my passion in life, and I plan on continuing to indulge in it as long as my body lets me.
I stepped out into a warm rain as I left the SAMHSA ADS Center meeting this morning. As I dodged the droplets, trying in vain to stay dry, it occurred to me: We at this conference are those raindrops. As individuals we are mere single drops of water. As small groups in our organizations we are a steady rain. But if we can join together on a larger scale, we become a massive rushing river.
Make no mistake, one single drop of water has power — as anyone who has tried to sleep through the surprisingly disturbing sound of a slowly dripping sink can attest. But it pales in comparison to the power of water drops combined into a massive rushing river — a force that can knock down buildings and carve through the hardest of granite.
I can feel the river swelling when I'm at Alternatives, and at meetings like the SAMHSA ADS Center gathering this morning. Over breakfast we had the opportunity to meet and put faces with the names and disembodied voices we have heard on so many conference calls. Even more powerfully, we had the chance to hear about the wonderful projects and creative ways in which these individuals and organizations were helping to change the national mindset about people with mental health issues.
Participants proudly shared updates on projects as varied as poetry for personal power, art as a tool to talk about trauma in a non-threatening manner, films about young adults in recovery from mental health and substance abuse issues, lessons learned from work with different nations of Native Americans, and so much more.
While the projects and outcomes that people highlighted were wonderful, the truly compelling part of this meeting was watching the connections happening around the tables as people spoke. Slowly, and then more rapidly, individuals started seeing connections between the work that was being done. Tools developed for one program were just the thing that another needed to move forward. Problems that seemed insurmountable in one community were offered new solutions from a similar problem in another region.
This is why national gatherings like Alternatives are so important to our work. You see it time and again: The energy changes around the table. People realize they are no longer working in isolation, are no longer the only voice for change. You sense there are others with you in the work. The water drops begin to coalesce into a downpour, and then the downpour becomes a river.
Suddenly, the impenetrable granite wall of public stigma against people living with a mental health issue doesn't look so formidable and unchangeable after all.
"Somebody steals your credit card and hits you for $1000 worth of charges, but you called and reported the card stolen right away. What's the maximum amount you are responsible for?"
Silence fills the room. A few guesses are shouted out. No one gets the right answer.
It may sound like a scene from a high school classroom, but today the young people are the teachers waiting patiently for a correct answer from their adult-aged students who laugh nervously around an enormous, hand-painted board game.
Created entirely by youth, the game simulates realistic situations from a youth perspective fostering conversation and learning in a fun, non-threatening format. As players move through the game they earn points while learning life skills such as today's credit lesson that has the adult players stumped and silent.
The game is the latest project of the Transitional Age Youth Initiative (TAYi), a program that serves and is operated by youth aged 16-25 who self-identify as having lived experience of mental health issues, or have been involved in the foster care or juvenile justice system.
Letty Elenes, staff member of PEERS and one of the coordinators of TAYi states that the program "gives youth in the system a voice by giving them the chance to attend national conferences like Alternatives."
The program also creates opportunities for its members to get involved in youth panels and focus groups, as well as creating training opportunities such as Wellness and Recovery Action Planning facilitation so they can move beyond being the recipient of services and have the skills to become youth peer specialists.
Funded through the California Mental Health Services Act and an Innovations grant from Alameda County Behavioral Health Care Services, TAYi goes beyond just educating and involving youth in existing services, but is designed to help youth actually change the system itself.
"We're part of the solution, not the problem," says Brianna Williams, also a PEERS staff member and coordinator of TAYi.
Members develop leadership skills, receive education, give community input, create change in the mental health system and contribute to ending stigma against people with mental health issues.
The youth running the Alternatives presentation have taught the adults in the room a thing or two about credit. Embarrassed groans go around the room as Brianna reads the game card revealing how much individuals who have had their credit card stolen are responsible for.
"The answer is $50. If you report your card stolen right away, the maximum you will be held accountable for is $50."
The young adults leading the workshop smile, perhaps sensing that they aren't just creating a board game, but are poised to change the game entirely.
The TAY Initiative Workshop featured an innovative life skills board game