7/30/10

My apologies to all for the time it has taken to do this. Here are the
workshops I attended:

1.) Contextual Understanding of Professional Boundaries.

2. )Persons in Recovery Foster Hope by Buiding Relationships Through a Self-

Help Center.

3.) Mental health Recovery and a Full Life

4. )Cognitive Enhancement Therapy

5). The Greying of Psychiatric Rehabilitation1

6.) Camp Wellness

Three of the workshops had no handouts or PP presentations due to technical

difficulties or other reasons.

Please bear with me as I preface this summary. Early in 1991 I went to work
for the Western Montana Regional Community Mental Health Center in
Missoula, MT. My prior experience with the SMI population had been two
years of graveyard shift in a small, county hospital's psychiatric ward. Truly
an education. WMRCMHC was a member of the USPRA and was instituting
the philosphy, principles, and practices thereof at that time. It was accepted
doctrine that individual's can be responsible for their own behavior, can make
their own decisions (right or wrong), natural consequences occur (and these
can be just as positive as they can be negative). Work was encouraged (we
had a lawn crew in season as well as supported employment), and members
had chores and tasks to accomplish daily. Also provided were classes to
teach members recognition of Warning Signs; Erroneous Thinking; Job
Hunting; general ADL's. Recovery was expected, as well as relapse and,
furthermore, relapse can be prevented or minimized with education, support,
hope and trust.

Point is, I came into this conference pretty well grounded in what was to be
presented. I will try to prvide you with what might be new info or at least
reinforcing what was already assumed or in practice.

1.) Professional Boundaries. This was one with no visual aids. No handouts.
No candy. No balloons. It seemed to me about equal with what one might
hear in an undergraduate class on ethics. Basically, be professional. Kindly
refuse offers of supper with the client and family, invitations to go out for
drinks, sexual overtures and the like; gifts are usually inappropriate. One
would have to use their own clinical judgement on a case by case basis if
clients offer gifts. Sometimes it might be OK. I think of a client who drew a
picture of flowers in crayon for me. Refusing it would have distanced the
client as she had put a lot of work into it and it was from the heart. It was a
simple expression of gratitude, liking, and in some ways, perhaps a point
marker in recovery. It hangs in my office today.

2.) Persons in Recovery Foster Hope. This was an enthusiastic presentation,

though confusing. There were only eleven attendees. My notes on the PP
handout read "This whole presentation has been confusing, irrelevant; seems
to be all inpatient oriented with references to locations unknown to at least
this member of the audience, i.e. "up on the third floor they..." or "in the
north building...". What I gleaned after a time was that groups were formed
in a state hospital where individuals were offered the freedom to experiment
with thoughts and behaviors. Individualism and trust were emphasizd, and
eclecticism in therapy encouraged. Then they kind of switched gears and
really lost me. I couldn't tell if they were talking about current inpt
populations or "Centers in the Community" . The presenter used incomplete
sentences often, and my notes on the last page are indicative of my sense of
having wasted my time with this one.

3.) Recovery: Life after SMI. This was a good presentation. Presenters (one
male and one female) told of their struggles through recovery/relapse cycles.
They spoke of the often early demise of SMI persons; of an over-use of meds,
sometimes to the exclusion of otherwise beneficial meds, and the fight to find
the right combo for themselves. They spoke of the importance of hope,
empowerment, voice and choice. They spoke of taking charge of their own
lives and health and creating a life of their own design. Not as easy as it
sounds. Mortality rate increases 35% if one has schizophrenia. Metabolic
syndrome, coronary artery disease, and dyslipidemia account for many
untimely deaths. In one study, of those on Clozaril, 10% died in ten years,
some 80% higher than the standard population. Meds are powerful and
dangerous: after medication administration it takes 200 days to make a
metabolic syndrome diagnosis (I didn't know this). Clozaril and Zyprexa have
been identified as the worst meds for unwanted weight gain. Of course
always use only the minimum meds necessary. Some drugs seem to
promote diabetes (Zyprexa, Clozaril), and Geodon may be the best substitute
for Zyprexa in some cases due to low weight gain. In many cases Trilafon
"worked just fine as an anti-psychotic". Patients should be fully informed
before taking any given med, as "side effects are in no way peripheral". Fully
informed, active treatment participation is best. MD's need to treat patients
as a whole, being aware of physical as well as psychiatric issues. But meds
alone do not good recovery make. Individuals need sustained support in
vocation, family and community as recovery is an ongoing process, a journey,
with setbacks and advances as in any endeavor, tho perhaps more trying to
the soul of an individual. And carry hope, hope, hope.

4.0 Cognitive Enhancement Therapy. An overview of the evidence-based

practice.