NEWS AND FEATURES FOR THE CONSUMERS, SUPPORTERS AND PROVIDERS OF PENNSYLVANIA’S BEHAVIORAL HEALTH SYSTEM

VOLUME 20, NUMBER 1 FALL 2011 / WINTER 2012

IN THIS ISSUE:

Powerful SelfSelf----HelpHelp Tool Takes Hold in Pennsylvania

------By Elisa Ludwig 333 Pennsylvania is a leader in adopting and disseminating WRAP® (Wellness Recovery Action Plan), a recovery and wellness tool that transforms lives.

Participatory Dialogues Level the Playing Field for Clients and Providers

-- By Elisa Ludwig 777 Allegheny and Chester counties promote SAMHSA’s Participatory Dia- logues, which create deeper understanding among individuals with mental health conditions, providers and other stakeholders.

Recovery and Little Green Apples -- By Brian McLaughlin 101010 Recalling his spiral into despair and back, the author – now a certified peer specialist – writes, “Any time someone is able to step outside them- selves to help another, healing can take place for both of them.”

COVER ART: “Politically Correct,” tempera paint on canvas, by Kath- erine Redick. (Redick named her painting after it was dis- played in the offices of Senator Robert P. Casey.)

Volume 20, Number 1

Tom Corbett, Governor Gary Alexander, Secretary of Public Welfare Blaine L. Smith, Deputy Secretary, Office of Mental Health and Substance Abuse Services (OMHSAS)

Jessica Bradley Director, Division of Recovery Services, OMHSAS

Susan Rogers Editor

The cover features a partial view of the painting, Lauren Rieser Shawl shown here in full. Publication Design Redick participates in the Magnificent Minds Project: http://www.magnificentmindsproject.com. Featured in “The Arts Inspire Mental Health Recovery” ( People First , Bryce Hewlett Summer 2011), the Project was created by Syngred D. Production Manager Briddell-Watts, MSW, an artist and mental health profes- sional. Participating artists have exhibited in galleries such as the Art Association of Harrisburg and the Mantis PUBLISHED BY Collective Gallery, as well as in the Harrisburg Hilton

The Mental Health Association of Downtown (as part of the Festival of Hope organized by the Mental Health Association of the Capital Region), at Southeastern Pennsylvania Temple University, at the Dauphin County Music and for the Pennsylvania Department of Public Welfare Wine Festival, and at other sites. “The locations of all

Magnificent Minds Project exhibits were spatial dona- tions, made by those in the community who wished to For a subscription to PEOPLE FIRST, join the fight against mental health stigma,” Briddell- see the back cover of this publication. Watts said. An online gallery, http://www.magnificentminds.net, If you received this issue in the mail, you are already solely devoted to displaying the work of Pennsylvania a subscriber and do not have to resubscribe. artists at no charge, was recently launched.

Have an opinion to share? Reaction to an article? Send e-mail to: [email protected] or regular mail to:

People First Mental Health Association of Southeastern Pennsylvania 1211 Chestnut St., Suite 1100, Philadelphia, PA 19107.

Letters are used at the discretion of the editors and may be edited for length.

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hen Mary Ellen Copeland ents improved in terms of reduced the most important things about developed the Wellness psychiatric symptoms, increased WRAP is that it’s a values-based Recovery Action Plan hopefulness, decreased self-blame, practice and a self-help tool,” said (WRAP®), a tool that improved quality of life and other Calhoun. “People can adopt it as WW helps people work toward factors. In fact, there was a direct they need to, to facilitate their own mental health recovery, she could correlation between the number of recovery.” not have predicted that, three dec- WRAP classes that participants at- ades later, it would become a na- tended and the benefits they saw. Lives Transformed tionally recognized best practice. The research supports what In Pennsylvania, WRAP has Yet this past July, WRAP was offi- those working with WRAP have been adopted by countless individu- cially entered into SAMHSA’s Na- known for some time – that WRAP als, many of whom have seen their tional Registry of Evidence-Based can promote real recovery. “We’ve lives transformed in the process. It Programs and Practices (NREPP), a been working on this research for has also been introduced at four list of scientifically proven and re- about five years,” said Katie Wilson, hospitals across the state, Calhoun viewed research projects on mental director of marketing and special said. “Pennsylvania is one of the health initiatives. projects at the Copeland Center for leaders in WRAP adoption. We of- This latest and most significant Wellness and Recovery in Brattle- fered voluntary trainings, and at all recognition for WRAP is based on a boro, Vermont. “And for someone four hospitals people participating WRAP has been adopted by countless individuals, many of whom have seen their lives transformed in the process.

randomized controlled trial, funded who has personally worked with in state hospital services, CEOs, doc- by the U.S. Department of Educa- WRAP, it was great to see these tors, staff and dieticians came. All of tion, the National Institute on Disa- positive results – though they were- a sudden, people were able to step bility and Rehabilitation Research, n’t entirely a surprise.” away from their role within the and the Substance Abuse and Men- Gina Calhoun, an advanced lev- hospital and just be in the room, tal Health Services Administration el WRAP facilitator and the exploring what they do for well- (SAMHSA). For eight weeks, re- Copeland Center’s director of well- ness. It was a really cool experi- searchers observed a thousand peo- ness and recovery education, ence,” she recalled. ple across the state of Ohio; some agrees: “The beauty of being includ- As more individuals are devel- of these individuals used WRAP im- ed in the registry is that now we oping WRAP plans, the mental mediately and some were sched- have the outcome and the evidence health system has started to recog- uled to adopt it nine months later. to say that it works.” nize their efficacy – and with that A series of tests measured the out- WRAP is a system for examining has come the need to address comes, including recovery, empow- one’s own wellness needs and the WRAP in policy terms. In December erment, self-advocacy, social sup- triggers and early warning signs for 2010, Sherry Snyder, acting deputy port, hopefulness, quality of life, the onset of illness. A WRAP plan secretary of the Office of Mental symptoms, coping, stigma and can include a wellness toolbox, a Health and Substance Abuse Ser- physical health perceptions. The daily maintenance plan, a crisis plan vices (OMHSAS), sent a letter clari- researchers found that WRAP recipi- and post-crisis planning. “One of fying the agency’s position on

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Fall 2011 / Winter 2012 3

… continued from page 3 WRAP: that individuals should have aged care organizations and provid- states like Pennsylvania move to- the right to choose whether or not ers that want to effectively imple- ward taking a closer look at evi- to include a WRAP plan in their ment WRAP. “It is OMHSAS’ ex- dence-based practices, we want to treatment plan, recovery plan or pectation that every county have make sure that WRAP is being of- file. “Making the WRAP mandato- peer specialists who are trained in fered with fidelity,” said Calhoun. ry, or even strongly encouraging WRAP as well as peers who are “That’s where the policy statement the development of a WRAP along trained as WRAP facilitators,” the from OMHSAS comes in. It answers with the expectation that it must be letter stated. questions about who can actually “It is OMHSAS’ expectation that every county have peer specialists who are trained in WRAP as well as peers who are trained as WRAP

facilitators.” While WRAP is a self-directed, facilitate WRAP and how much included in the person’s record, is values-based concept, its effective- training you need.” For instance, contrary to the values and ethics of ness is also contingent on following evidence has shown that people WRAP,” the letter states. certain principles; and, as WRAP who have gone through five-day However, the letter goes on to grows, the Copeland Center is WRAP facilitator training were best suggest possible approaches for working to ensure that people have skilled and able to promote the val- counties, behavioral health man- access to quality education. “As ues of WRAP.

- (left to right) Gary Andricks, Audrey Garfield, Jean Rogers, Flora Releford, Michelle Maczka, Jane Winterling; (front) Margo McMahon

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… continued from page 4 The Copeland Center is now Hospital, I still hadn’t offering WRAP refresher courses for heard the words ‘mental existing facilitators, which it recom- health recovery.’ It wasn’t mends they take once every two until I went to Massachu- years. “These courses help people setts and learned about keep up with a growing body of WRAP that the possibility knowledge out there and stay up to of recovery for my life re- date with the new information,” ally began to shine,” said said Calhoun. Calhoun. “What was also important was that the fa- International Impact cilitator kept telling us it Celebrating the international was voluntary. I thought, impact of WRAP, the Copeland ‘Man, I haven’t heard that Center sponsored a WRAP Around word as it relates to my the World conference, held in Phila- wellness in a long time.’ To delphia last August. The conference witness people who had offered a wide range of sessions, written a plan and were from WRAP for people with eating now passionate and satis- disorders to finding funding for fied within their lives made WRAP training. “The conference a huge difference. I sat was an excellent time for us to down and began to write bring together people from around my plan. And just by writ- the world who are using WRAP and ing, my brain shifted to have adapted it to what’s needed in wellness thinking. I their local community; people who knew I would imple- are working with children or with ment it.” Director, Wellness and Recovery Education specific populations could come to- Wilson, too, found Copeland Center for Wellness and Recovery gether and share their experiences,” that the introduction to said Wilson. Judith Cook, Ph.D., the WRAP was a life- lead investigator of the Ohio re- changing experience. “The value are without judging or pushing search, was on hand to present the was meeting with people who them in any specific direction.” “We’re really witnessing people making changes in their lives.” results of the study. viewed me with unconditional high The possibilities for WRAP are “What was neat was that we regard. It was the first time I was on just opening up. While WRAP has had people learning about WRAP an even footing with people who traditionally been adopted by indi- for the first time alongside people were doing well when I was not,” viduals with mental illness, it can who have been doing it for years,” Wilson said. “The fact that they also be viewed as a way to engage Calhoun said. “WRAP facilitators could overcome what they had communities. “If we can use WRAP were able to refresh their skills, and gone through opened up to me the not only as a tool for recovery and we here in Pennsylvania could see hope that I could have whatever I self-discovery but also as a way for what other states are doing as far as wanted for my life. To me, what people to be human beings moving implementing it into their systems.” sets WRAP apart is that you’re toward wellness – whether it’s peo- For Calhoun, the belief in the meeting people who live by a code ple participating in mental health power of WRAP runs deep – and of ethics and values, and one of the services, stakeholders, family mem- it’s based on her own experience. greatest values is to accept people bers or anyone – WRAP can be uni- “Even after leaving Harrisburg State for who they are and where they versal, and it can be a way to unify

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Fall 2011 / Winter 2012 5

… continued from page 5 “Our group in Ichikawa (Japan) is saying that WRAP is a common language in despite of differences in cultural background and language barriers.”

people,” Calhoun said. host of the conference, Pennsylva- spent five days in Ichikawa (on the What’s more, WRAP’s applica- nia is clearly moving forward. I’m outskirts of Tokyo) and three days tion may go well beyond the men- looking forward to seeing how in Kyoto. They visited clubhouses tal health system. “WRAP provides WRAP grows in the state from here and sheltered workshops, and a framework for people who have on out. Being part of WRAP has spoke at a symposium attended by challenges; whether it’s a personal been empowering – we’re really approximately 200 people. or physical or mental health chal- witnessing people making changes The Japanese – mostly consum- lenge, it gives you a way to help in their lives.” ers along with some providers and yourself. We’d like to see it used in some psychiatrists – “were very ex- more hospitals and elementary WRAP in Japan cited about this new knowledge school settings; there are so many Others in Pennsylvania are tak- and self-help tool,” Whitecraft said. opportunities,” Wilson said. ing WRAP across the world. In In March 2007, Whitecraft re- Calhoun said that in the near 2006, Jeanie Whitecraft of the turned to Japan to teach WRAP future, she is also hoping to intro- Mental Health Association of South- facilitator training (with Stephen duce WRAP to the children’s mental eastern Pennsylvania traveled to Pocklington, then of the Copeland health system. “As a leader, as the Japan to teach an introduction to Center) on Kurume, a small island WRAP. She had been south of the main island of Japan. advised that she might In an e-mail, Fumie Hisanaga of have to tailor her the National Centre of Neurology presentation to accom- and Psychiatry wrote, “Our group modate the natural re- in Ichikawa is saying that WRAP is a serve of the Japanese common language in despite of dif- people. Instead, White- ferences in cultural background and craft said, she found that language barriers.” “people were very en- “That’s what peer support is thusiastic and very much about,” Whitecraft said. “Despite wanting to participate.” the language barrier, it was possible (Whitecraft’s trip was to make connections with people part of a two-year infor- on a very profound level.” She cit- mation exchange grant ed a letter from one of the training from the Center for participants, who wrote that, previ- Global Partnership of ously, she had been having “ill The Japan Foundation.) thoughts about myself, which has The Japanese under- [sic] been hurting me.” But, she stand the idea of well- continued, “It was when I encoun- ness, Whitecraft said. “A tered WRAP that tells me to do lot of people already do something I feel good about, that it what we say we should is ok to aggressively pursue my hap- do. For example, in Ja- piness, to get my self-esteem back. pan, taking a nice hot With those messages, scales fell off bath as a wellness tool is from my eyes. . . . Now, WRAP part of the culture.” work/process itself makes me feel The Americans, who good.” She signed the letter with traveled with interpreters, “Hope.”

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magine a circle of chairs. The Thompson, now chief medical of- cilitators to run their own dialogues. people sitting on those chairs are ficer at Recovery Innovations in Notes from Allegheny County ses- referred to by their first names Phoenix, Arizona, introduced the sions are posted to I only – and although there are concept in Allegheny County in www.coalitionforrecovery.org. equalI numbers of medical profes- 1998, modeling it after a session in “In a clinical setting, there’s al- sionals and individuals with psychi- New York State that he had partici- ways a barrier and a power imbal- atric diagnoses present, no one pated in. The committee followed ance so people are often intimidat- knows who is who. Two facilitators suit in 2001. ed,” Goldstein said. “But in a dia- introduce a previously agreed-upon logue, people are speaking from topic. Discussion – honest, personal, A Powerful Experience their heart. I think it’s important to unedited, surprising – ensues. Recovery consultant Sarah learn how to talk to one another. It In Pennsylvania, two counties Goldstein attended the first dialogue removes the stigma, it improves have adopted what the Substance and found it a powerful experience, communication, and it improves Abuse and Mental Health Services one that she immediately wanted to cooperation and collaboration be-

“In a clinical setting, there’s always a barrier and a power imbalance so people are often intimidated. But in a dialogue, people are speaking from their heart.”

Administration (SAMHSA) refers to help recreate for others. “From cause it helps you understand the as Participatory Dialogue, enabling there, we worked toward develop- other person’s role by hearing them better conversation and deeper un- ing more dialogues on a regular ba- speak about it. It breaks down the derstanding among individuals with sis. In 2005 we joined the Allegheny barriers.” mental health conditions, providers County Coalition for Recovery,” Goldstein is also quick to point and other stakeholders within a safe said Goldstein, now the Consumer- out the difference between a dia- environment. Participatory dia- Provider Collaborative Committee’s logue and a meeting or focus group logues encourage healthy conflict – co-chair, along with Dr. Wesley that might bring together clients and disagreement without disagreeable Sowers, medical director of the Alle- providers: “This is not about making behavior – and, most importantly, gheny County Office of Behavioral repairs, or fixing what has been bro- help to erode prejudice by giving Health. ken.” Yet dialogues can also lead to faces and voices to mental health Since 1998, there have been 40 real change by encouraging partner- conditions. dialogues in the county, generally ships between participants and help- Leading the charge in Pennsylva- between clients and providers, al- ing to change attitudes and practices nia is the Consumer-Provider Col- though family members are some- throughout the behavioral health laborative Committee, based in Al- times invited to participate. Gold- care system and beyond. legheny County. Dr. Kenneth S. stein has trained three groups of fa- … continued on page 8

Fall 2011 / Winter 2012 7

… continued from page 7 Chester County In 2006, Chester County fol- lowed Allegheny County’s example, adopting participatory dialogues with training from Goldstein and Sowers. An initial Dialogue Commit- tee supported by Community Care Behavioral Health and Compeer Chester County (a program of the Mental Health Association of South- eastern Pennsylvania) was con- vened, with 14 members – seven providers and seven clients – repre- senting various agencies. Largely responsible for Chester County’s interest in the model, Compeer Chester County founding program director Rob Chisholm recalls that a fair amount of prepa- Rob Chisholm, founding director, Compeer Chester County (left), and ration went into the process, in- Jamie Messersmith, care manager, Community Care Behavioral Health cluding staging a mock dialogue before opening the sessions up to spectrum can get together and dis- In Chester County, an initial guests. “We practiced internally be- cuss issues very candidly and re- group of 40 to 50 people is divided fore we held our first official dia- spectfully,” said Karl Schatz, who into two smaller groups. There are logue,” he said. first attended a dialogue when he two separate dialogues and then the “People from different walks of life and different parts of the service spectrum can get together and discuss issues very

candidly and respectfully.” was leaving a step-down groups reunite for feedback and a Jamie Messersmith, care man- program. “And all of these people wrap-up discussion. ager at Community Care Behavioral who wear different shoes and hats Health, was an early convert to the when they walk out of the door Personal Transformation power of fair and open exchange. become very similar during the time “The common denominator is “I was working in the mental health they’re talking to each other.” that most people walk away feeling field as a coordinator of residential In 2007, Messersmith joined that they have experienced some- programs for adults, and I was invit- the committee and was later elected thing very unique,” said Chisholm. ed to participate in the first dia- to be its co-chair along with Karl “Whether it’s a provider or a con- logue,” she said. “I was so enthused Schatz. The committee meets sumer, the takeaway is personal about the experience, about the fact monthly and plans topics for the transformation. People walk away that I could sit in a circle with clients semiannual dialogues, which some- and go back to their roles changed and providers and have a conversa- times emerge from a previous dia- in some way. It’s the ultimate form tion about a topic, that I knew I logue. Topics might include miscon- of recovery, changing how we con- wanted to join the committee.” ceptions about mental health recov- duct ourselves in relationships.” ery or what constitutes decent, af- “The idea is to have a genuine Another World fordable housing. Only invited par- conversation without filtering your- Dialogues can offer a rare ticipants can attend the event. Par- self, without trying to be politically glimpse into another world. ticipants are chosen by the commit- correct,” Messersmith said. “It takes “People from different walks of life tee and invitations are delivered in away the hierarchy. What we’ve and different parts of the service person. found is that someone might come

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… continued from page 8 from their workplace as a doctor a crisis situation.” In both cases, par- see the children’s system involved in but when they’re here they might ticipants came away from the expe- participatory dialogues, particularly share an experience that’s personal, rience more open to others’ points at the age when youth transition or from a family member.” of view. into the adult system. In 2009, Messersmith and For his part, Chisholm would Chisholm introduced a new change A Different Tone like to see more counties adopt the to the Chester County program: Whereas police and other peo- model, which he said is out there while in the past dialogues had tak- ple who regularly encounter indi- for the taking. “The dialogues really en place only between mental viduals with mental health condi- give people in recovery a new sense health consumers and providers, tions receive sensitivity training and of recognition about their unique “All of these people who wear different shoes and hats when they walk out of the door become very similar during the time they’re talking to each other.” they decided to branch out and in- seminars, the tone is very different role, and a neutral territory to vite other members of the commu- from a participatory dialogue. “In come together,” he said. nity. “We wanted to include com- fact, the police chief asked us to do Allegheny County is still work- munity mental health stakeholders two mini-dialogues with his depart- ing on developing tools to measure who don’t necessarily provide men- ment so they could have that expe- outcomes and find out how partici- tal health services but who are in rience,” Messersmith said. “In the pants are using what they glean some way impacted by the system, end, he has become a community from the dialogues. In the mean- such as probation [and] hospital stakeholder beyond what we could time, Sarah Goldstein has noticed staff and police,” Messersmith said. imagine.” the impact of dialogues in her own Sometimes the idea of leaving She said they had a similar ex- relationships with providers. “I a professional identity behind can perience with a probation officer have learned how to talk to my be difficult, as in the case of a local who works with reentry for people doctor better: listening to how oth- police chief who was invited to at- coming out of the justice system. er people communicated with their tend. “He physically could not do “He is now trying to get more peo- doctors allowed me to learn how that be- to do it,” cause he Goldstein not- came “It’s important to learn how to talk to one ed. “We have dressed a good rela- in full uni- another. . . . It breaks down the barriers.” tionship, and form,” part of that is Messer- just learning smith recalled. “I asked him to put ple from the legal system involved that doctors are people, too.” on a nametag and he said he didn’t because he believes the dialogues For Schatz, the power of the need one. But he came up to me at are a new way for the systems to concept is in the exchange of ideas. the end of the experience and said collaborate for future growth and “In a dia- he saw great value in it. It was the transformation. The amazing thing logue, there is first time he was able to speak to a is that changes might not come up no right and mental health client in recovery; right away but you see things devel- wrong. Eve- typically, people in law enforce- op.” ryone is enti- ment encounter clients when Messersmith said it has some- tled to their they’re not in a healthy place. It times been challenging to get psy- opinion and was the same for the clients: it was chiatrists to attend, but they are everyone has the first time they’d spoken to a working on strategies for making the freedom police officer when they weren’t in that happen. She would also like to to express it.”

Fall 2011 / Winter 2012 9

like to say that God gifted me with an average mind. A year passed and I grew bored and angry. I remember University was a mighty struggle; however, I made sitting in the dark for hours, thinking and praying. I finally grades and finished up with a master’s degree. My said, God, you know how hard I’ve worked at the universi- early career was marked by some great successes and ty; but if this is all you want for me, so be it. I some equally great failures. But, as time passed, my Then the phone rang. An old friend who knew of my moodsI became ever more extreme. At some level, I knew situation told me that the local base service unit – jargon for what was happening: I was cycling. However, the thought a community mental health center – was looking for a new of being mentally ill was too frightening, too terrible. I en- mental health advocate. I was hired shortly thereafter. That gaged in magical thinking: I would say to myself, a person was 16 years ago; today I am both an advocate and a certi- with my education should be immune from mental illness. It fied peer specialist (CPS). is often said that depression is “anger turned inward,” and Being a CPS has helped me make sense of my life; it that describes my experience. I wasn’t diagnosed with clini- gives me the structure that for a time was painfully missing. cal depression until age 30, when my life so overwhelmed And I firmly believe that being a CPS helps me better con- me that I began expressing that anger by suicidal thoughts, trol my symptoms. Any time someone is able to step out- self-injury, and periodic substance abuse. It always seemed side themselves to help another, healing can take place for dark outside and, obsessed with violent thoughts and imag- both of them. es, I became convinced that everyone was out to get me. As I lingered in denial, my mental illness became more Winning Hearts and Minds disruptive. I never was fired from a job – because I would Stigma can be a barrier to healing. And, unfortunately, quit first. Thoughts of suicide led to hospitalizations, and despite the fact that the mental health system I found myself my secret was out. in (in northwestern Pennsylvania) was and is deemed pro- gressive, stigma is still rampant – and a progressive leadership and public policy do not always ensure a progressive line staff. Initially, I aggressively confronted professionals whom I found prejudiced. This approach was met with resentment, anger, and a general failure to be persuaded. Then I discovered that, to be heard, I needed to be more subtle, gentle, even humorous. For exam- ple, once in a meeting, a master’s level professional remarked, “Well, her apartment is clean . . . for a consumer.” To which I replied, “I am a consumer and my house is spotless.” There was dead silence. The professional blushed with anger, or embarrass- ment. I quickly added, "Maybe that is just because I am unnaturally close to my mother.” Everyone Brian McLaughlin, MS, has worked in the public mental health system much of his adult life. For the past 16 years he has served as a mental health advocate laughed, including the offending professional. Be- at the mental health base service unit now named Erie County Care Manage‐ cause she was not threatened, she heard my message ment. Brian was in one of the first classes of certified peer specialists trained in loud and clear – and changed. northwestern Pennsylvania; he completed his CPS training in spring 2006. I made another mistake when first I carried the title of advocate: I became, as the poet said, “an Despite confidentiality regulations, word of my illness island onto myself.” Instead of becoming a member of the traveled swiftly though the system that had once employed team, I made myself an adversary, ready to pounce on eve- me. When I applied for a job stacking dog food, the manag- ry issue. I found myself shunned and ineffective. er informed me that one of my previous employers in the I quickly adopted a new style and looked for ways to mental health arena said that they “would not hire me un- support the team. If I uncovered a problem, I learned to der any conditions.” So my parents helped me apply, suc- bring it to the team – armed with several creative solutions cessfully, for disability benefits. and a willingness to pitch in.

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… continued from page 10 I also made it a point to let the professionals I worked so compromised that they cannot possibly fulfill the role of with get to know me – and I got to know them. Together, paraprofessionals. we found common ground. This led to frequent invitations Here is a story that proves the critics wrong. to lunch and other social gatherings. I went from being “that crazed manic-depressive zealot” to being Brian. In my mid-20’s, I experienced a dark depression that led Even now, I still make mistakes. Like my professional col- to my first psychiatric hospitalization. I chose what I thought leagues I am not perfect and, on occasion, mishandle things. was the most modern inpatient unit in my small northwest- On these occasions, a sincere apology, coupled with a visible ern Pennsylvania community. effort to reform, is strong medicine. I was admitted on the weekend, so I didn’t get to see a As pioneers of a new healing profession, we must doctor; instead, I was given a room and a pair of blue-and- demonstrate our unique ability to help our peers attain ever white-striped pajamas to wear out on the floor. I quietly greater levels of recovery, self-determination, and health. In took my place on one of the many couches and, with my the end, our paths as peer specialists will be as unique as the peers, stared at the big-screen TV. The hours passed slowly as paths we took towards our personal recovery. we sat in silence, alone with our suffering. The nurses and technicians seemed to power-walk through the room once an Little Green Apples hour; the rest of the time the staff peered at us through a Although my personal path window. has led me to feel secure in my Then came Shawn, whom I had once looked after in a recovery, sometimes I find my- community outpatient treatment program and group home. self in transition from mania to We had attended the same high school, where he had strug- depression. Mania is wonderful gled through special ed. He had been diagnosed with early as it makes me fearless and re- onset schizophrenia, and his symptoms were profound and moves all limits. Mania is also terrible as it makes me fearless disabling. He also was strangely brave and, most of all, car- and removes all limits. Mania is like listening to the Rolling ing. Stones with the speakers blown, and is as bright as a sunflow- Shawn knelt in front of me. With a deeply concerned er painted by Van Gogh. Depression is as silent as the grave, expression, he said, “Brian, what happened? What is wrong?” and just as dark. I slowly replied that I was having a little trouble with depres- But I am blessed with parents who love me to a degree sion – holding back some because I was worried that I would that surpasses my comprehension. They have been with me upset him. Still, it felt wonderful to be given the opportunity though all the suffering. to talk to a genuinely concerned person. However, something once happened that at first I found Shawn responded, “Brian, it’s going to be okay. I will troubling and, later, I came to understand. Depressed, I called pray for you.” home. My dad answered and I told him that, once again, I Just then a nurse approached and sharply told Shawn, was cycling down into a depressed state. Dad paused and “Leave him alone.” Shawn hung his head and retreated to his then handed the phone to my mother. I repeated what I had room. The nurse got her wish: I was left alone with my illness told my dad. My mother also paused and then said, “There is for the next 48 hours: no medication, no therapy, no interac- a sale on Granny Smith apples; would you like me to get you tion with the staff – except at the end of each shift, when the some?” Confused, I said yes, thank you; and we politely said mental health technicians ordered me to the front desk and, goodbye. in front of the whole floor, loudly interrogated me about my What had happened to my loving and supportive par- symptoms. I soon realized this was born of their need to fill ents? Then I understood: they still loved me but simply had up the log with something before their shift ended. no more to give. My dad had to hand me off. My mom had In short, the greatest healer I have encountered in my 20 to talk of little green apples. years of experience working in the public mental health sys- I did get my little green apples, and I put them in a bowl tem was another peer. Sadly, Shawn has tragically passed on my kitchen table. They remind me that I am loved and away. God speed, Shawn; I am going to be okay, just like that even the worst depression will pass in time. you promised. Praise and Criticism The idea of training individuals with psychiatric histories as paraprofessionals “My little green apples remind me that actively engaged in the care of their peers has received both praise and criti- I am loved and that even the worst cism. Supporters assert that mental health consumers are naturally qualified to help their peers. Critics suggest that depression will pass in time.” persons with serious mental illnesses are

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