OVERVIEW

The National Institute of Mental Health, in its Strategic Plan, states it wants to strengthen partnerships between NIMH and its stakeholder groups, including patients, families, and advocacy groups; as well as develop psychosocial and environmental inter­ventions to improve adherence.  It also claims it wants to support research that tailors psychosocial and biomedical interventions to different kinds of providers and different intervention settings (e.g., schools, mental health clinics, community health clinics).

We are proposing environmental and psychosocial interventions in a community based setting, where increasing harmony will be the primary focus, and will be staffed primarily by individuals who have received a diagnosis of a serious mental illness, and have been able to achieve substantial recovery.  Cactus Flower Harmony Center is the proposed name of the facility. 

While our clients may have a reputation of being rather prickly, we believe they each have the potential to bloom, and become assets to the community.

It has been six years since The New Freedom Commission’s final report to the President; Achieving the Promise: Transforming Mental Health Care in America was issued.  It listed six goals: Americans Understand that Mental Health is Essential to Overall Health; Mental Health Care is Consumer and Family Driven; Disparities in Mental Health Services are eliminated; Early Mental Health Screening, Assessment, and Referral to Services are Common Practice; Excellent Mental Health Care is Delivered and Research is Accelerated; Technology is Used to Access Mental Health Care and Information.  Grading the States; NAMI's report card on Mental Health in America gives a failing grade of D to both the State of Nevada and the Nation. 

While some things have improved during the past six years, in many ways things remain the same.  Clients complain less of being treated like property, or lab rats, but treatments are inadequate and information about what is available has been severely lacking.  Stigma is still rampant, partialy due to government forms, including Medicaid forms having been prepared by individuals without knowledge of recovery.  Some staff have been reluctant to adopt recovery based models, and readmission rates are still unacceptably high[1].  It can be a difficult job to be either a caregiver or a patient in a psychiatric facility.

Cactus Flower Harmony Center will help Nevada achieve the promises made in the Commission’s Report, and make transformation of the mental health system a reality.  It is a consumer driven system which will meet the needs of both consumers and families, increase the overall health of persons with a mental health diagnosis, refer individuals to services which can further aid their recovery, and do research on methodologies that have a direct, immediate impact.     

Cactus Flower Harmony Center will help meet the goals of both the NIMH and The New Freedom commission, reduce readmission rates, help transform the mental health system by increasing the numbers of individuals who are able to substantially improve their lives, thereby not only reducing stigma, but have the mainstream population become curious as to what is being done right, and begin seeking similar help whenever they begin to feel the pressures of stress.  Stress is an important aspect in both the onset and relapse of mental illness[2], and a primary function of the center would be on helping people to deal better with the stresses in their lives. This will include the use of Sound Therapy using Tuning Forks[3].

Cactus Flower Harmony Center will be primarily peer run.  Those of us who have been through the system can be more sensitive to the needs and perspectives of clients, more easily avoiding policies and procedures which add to the stress, stigma and frustrations clients sometimes experience.  Seeing former patients in positions of responsibilities would also add hope to the lives of individuals who are sometimes mired in grief[4], perceiving incorrectly that they have no possible future outside of homelessness, jail, prison, or hospital.

INTAKE AND SCREENING

As part of our intake and screening procedures, we will add two items not typically considered standard in the mental health environment, although some facilities, such as The Meehl Foundation in Texas[5], use at least one.  There is, however, scientific evidence that both of these can impact not just mental health, but overall health as well.

Providing a Hair Tissue Mineral Analysis[6][6] (HTMA) as a standard screening test could help to eliminate inaccurate diagnoses[7], identify deficiencies (or overabundances / ratio problems) of minerals, as well as uncover toxic substances which could impede recovery. 

A Chiropractic[8] exam would help to identify any blockages to the cerebrospinal fluid that surround and protect the brain, and flows to the spinal cord.  As this fluid also bathes the brain in nutrients, restrictions or blockages would impede the ability of the brain to function at optimal levels.  To minimize discomfort, as well as to reduce risk of injury to clients, whenever possible we will utilize a chiropractor trained in Network Spinal Analysis, or another soft touch chiropractic modality which eliminates the bone crunching usually associated with chiropractic care.  Naturally, whenever a client has been established with another chiropractor, we would not interfere with that relationship.

During intake assessment, the client will be made aware of the various services which can be provided.  Clippings for HTMA may be made at this time as well, although depending on answers regarding recent use of some hair products, this may be done at a later time.  We expect to utilize a licensed laboratory for HTMA, although at this time we have not yet determined which one(s).  Arrangements to set up an initial chiropractic examination will also be made at this time.

For clients who continually feel tired or fatigued we suggest they check the status of their thyroid gland.  It is a simply procedure that can be done at home using a simple thermometer.  First, put an oral thermometer by your bedside.  If you use a mercury one, shake it down to 96 degrees first.  When you awaken in the morning, place the theromometer in your armpit and leave it there for 10 minutes while still lying in bed.

Note:  Men can take their temperature any day.  Women in their menstrual years get the most accurate reading on the second or third day after menstrual flow starts. Before the first menstrual period or after menopause, the temperature may be taken on any day.

Anywhere between 97.2 and 98.2 is considered normal.  If your temperature falls below this range, it indicates a sluggish thyroid or hypothyroid condition.  If it is above this range, your thyroid is overactive.  Talk to your doctor about this, but one or two drops of iodine a day can increase your metabolic rate, and reduce cholesterol levels as well.  (Caution:  never take topical iodine internally, as it is poisonous.)  Use an iodine supplement obtained from a health food store, or your pharmacist. 

We expect to be open to any individual who feels in need of mental health recovery services.  Some individuals may be slow to accept any services, but they will be welcomed to observe and participate as they become ready.  Daily activities, such as walking meditations, informal groups, recurring group presentations, basic recovery groups, as well as some one on one peer mentoring will be available to all who wish to participate.  Due to various constraints, including trained personnel, our more structured services, including Sound Therapy using tuning forks, will be limited to those formally enrolled in our programs.  At this time we expect that 30-35 individuals will be the maximum number of formal clients we will be able to serve.  Our structured program will take approximately six months to complete.  We hope many of our first graduates will go on to become volunteers, and eventually staff members.

Individualized Recovery Plan

An individualized recovery plan will be drawn up with the active collaboration of each client.  This will be updated regularly as to progress and goal changes. 

PEER MENTORING

The principles of the National Consensus Statement on Mental Health Recovery[9][9], Hope, Self direction, Individualized and Person Centered,   Empowerment, Holistic, Non-Linear, Strengths Based, Peer Support, Respect, Responsibility will be implemented and followed at the center. 

Peer mentoring, which has been proven to be effective in various studies[10] will be a major portion of our operation, giving both individualized mentoring as well as groups on various aspects of recovery.  We will also have group activities, such as stretching exercises, meditation, exercises to help get out of bed when overcome with depression, study groups, art classes, and guest speakers who will give presentations on various subjects which may aid an individual in their recovery process.

Individual Peer Mentoring

Individual Peer Mentoring[11] will vary with the individual needs of each client. While this can take the form of crisis management, most often it is geared towards helping the individual come to an understanding of the problems they are encountering, and of the steps needed to successfully meet the challenge. 

GROUP PRESENTATIONS

Recovery 101

Recovery 101: The Basics of Recovery[12] contains a brief talk on the National Consensus Statement on Mental Health Recovery; as well as on the six stages of Grief - Shock, Denial, Bargaining, Anger, Guilt, and Acceptance - The journey from shock to acceptance is, perhaps, the greatest obstacle on the road to recovery.  The L.E.A.P. program, Listen - Empathize – Agree - Partnership Communication skills that can work to aid an individual develop a recovery plan… and help get back on it should they relapse. Including time for questions, this presentation takes about 90 minutes.


 Recovery: A Path for Difficult People

Recovery: A Path for Difficult People[13] is on helping people recognize their difficult behaviors, and giving them the tools to be able to change.  Its three main components are A. the humorous video series: How to Deal with Difficult People, by Doctor Rick Brinkman and Dr. Rick Kurschner; B. An introduction to cognitive therapy[14] and C. The Transforming Anger homework assignment, condensed from the book, The Art of Happiness by the Dalai Lama.  This presentation, including answering questions, also takes about 90 minutes.

Enhancing What’s Right: Alternative and Complementary Treatments

Enhancing What’s Right: Alternative and Complementary Treatments[15] is an overview of the various types of alternative and complementary treatments available, and the basics of why they may work.  Strictly speaking Alternatives are those which are used without medications while Complementary treatments are the same modalities, but used in conjunction with medications.  This presentation allows for questions following a demonstration of Sound Therapy using tuning forks, and also takes about 90 minutes.

Other presentations will be made available from time to time, including having guests speaking and demonstrating about various topics.  These will be open to family members and other interested parties as well.

Groups

These are peer mentoring groups.

Facilitating Recovery

Facilitating Recovery, while currently being revised, is an eight session group giving the basics on mental illness and recovery.  It expands on the information in Recovery 101, including information about journaling, and how it can aid recovery, and The Juke Box method for stopping voices.

Recovery: A Path for Difficult People

Recovery: A Path for Difficult People[16] is a sixteen session group helping people to recognize their difficult behaviors, and giving them the tools to be able to change.  Its three main components are A. the humorous video series: How to Deal with Difficult People, by Doctor Rick Brinkman and Dr. Rick Kurschner; B. Discussions on the basic elements of cognitive therapy and trigger recognition. C. Transforming Anger homework assignment, condensed from the book, The Art of Happiness by the Dalai Lama.

Peer to Peer

Peer to Peer[17] is the nine session NAMI scripted recovery course.  Each of the major mental illnesses is briefly covered during the nine session course.  Sincere uncritical acceptance of yourself and others, while developing mindfulness are the underlying themes which help individuals develop the tools for relapse prevention.

Commonality of experience irrespective of diagnosis
*      Trauma as an integral part of the experience of mental illness
*       Impact of social/cultural contexts and resulting discrimination
*       Relapse prevention as a tool for understanding what has happened
*       Awareness as a skill that can be developed

SUPPORT GROUP(S)

There will be a need for support groups for individuals to talk about the difficulties they are encountering, make suggestions, and give support to each other.  It is likely these groups will coalesce around certain shared experiences, such as combat veterans, former sexual abuse victims, former child prostitutes, etc.  These groups will be generally self directed, choosing names, etc. among themselves.   These groups may also serve as an advisory group, giving suggestions as to improvements for the Center.

STUDY GROUPS

Get Out of Your Mind & Into Your Life is a self help workbook on cognitive therapy by Steven Hayes M.D. of UNR and is expected to be the focus of one or more study groups, enabling peers to help one another in their recovery efforts.

The Five Wisdom Energies, by Irini Rockwell is expected to be the focus of another study group.  This book, which presents a Buddhist way of understanding personalities, emotions, and relationships, can be useful to anyone, regardless of any religious affiliation, who wishes to either better understand themselves or others better.  From the (Tibetan) Buddhist perspective, there are five basic personality (or energy) types, each of which can display itself in either a neurotic or a wisdom fashion.  Exercises in the book are aimed, in part, at helping to understand other personality types, while some are geared towards changing neurotic actions into wisdom acts.       

Other Groups

Other groups, such as WRAP, which is one of the earliest courses on Emotional Intelligence, helping individuals sort out emotions which may have been distorted due to early childhood trauma, will be added as trained mentors are available.

ALTERNATIVE AND COMPLEMENTARY TREATMENTS

The bio-medical model is not the only medical model[18].  There is a Buddhist medical model, an Ayurveda medicine model, a Homeopathic medicine model, a model from traditional Chinese medicine, even a Shamanic model, and parts of each are slowly being incorporated into what is becoming known as the Vibrational Medicine model[19].  The Vibrational model is in harmony with the advances made in physics during the past century.  These are generally termed Alternative and Complimentary Treatments[20] (A/C).  They are considered Alternative when used in place of prescribed medications and Complimentary when they are used in addition to prescribed medications.  A modern recovery based system will need to be accepting of all methods which prove effective, and we expect to implement promising methods, and document how their effectiveness.

Meditation

Meditation is perhaps the most widely used Vibrational ( or A/C) modality, and we expect to have two fifteen minute meditations each day.  One will be a sitting meditation, where individuals will be encouraged to sit quietly, focusing solely on their breathing, dismissing all thoughts from their minds.  The other will be a walking meditation, where the minds focus would be directed at each step; the lifting, moving and placing of each step.  Meditation practice has been proven to help individuals quiet their minds, as well as increase the activity of the left pre-frontal lobe, which is activated when an individual experiences positive emotions, while the right pre-frontal lobe is activated during negative emotions.[21]         Laughing Meditation will also be introduced.

Sound Therapy Using Tuning Forks

Sound Therapy using tuning forks is a vibrational ( or A/C) therapy.  The initial session last about 15 minutes, successive sessions are gradually increased to about one hour during the sixteen weeks of recommend therapy.  During these sessions a series of specially designed tuning forks, which are in harmony with each other, are placed, one by each ear, producing a calm relaxing effect in 97-98% of individuals.  For those few individuals who find the experience unpleasant, it will be discontinued.  There is a basic pattern of harmonics, long and short versions, which will be given, plus 19 additional specialized patterns or motifs, as well as 7 matrices (very short patterns) which will be individualized, depending on the client.

Why Sound Therapy using Tuning Forks produces a calming and relaxing effect.

Cerebral spinal fluid is responsible not only for protecting the brain and central nervous system, but for flushing the system to remove waste products produced by the brain.   This fluid is replaced every five hours.  Its main source of movement is its own hydrostatic pressure, the pressure of its own production.  It is likely that with the introduction of a standing wave into this fluid, the natural consequence of vibrating the cranial bones would cause rhythmic displacement and movement of the fluid.  It is speculated that the movement created by the perfect 5th interval in some way coincides with the cranial rhythmic impulse.  The cranial rhythmic impulse is the coiling and uncoiling of the central nervous system which in cranial osteopathy is a basic healing mechanism of the body.  This coiling movement and the movement of the CSF are interdependent on one another.
 
The body vibrates at all levels from the sub-atomic all the way up to the level of organism.  Each part and system of the body has its own unique frequency pattern, for example, the receptors and ligands, which bring about chemical changes in the body such as endorphin reactions, vibrate into place. Ligands are neurotransmitters, steroids, which include sex hormones, and peptides, which regulate practically all of the life processes.  Receptors are sensing molecules on the surface of cells waiting to receive the information from ligands.  “...2 voices – ligand and receptor- striking the same note and producing a vibration that rings a doorbell to open the doorway to the cell”, says biophysicist Candice Pert in her book, Molecules of Emotion[22].

 In the past the model used for neurotransmitters and their receptors was a static one of the keyhole and the key.  We now know that they are both vibrating in a kind of harmony so that the neurotransmitter can couple with the receptor to bring about the changes that include all emotional reaction.  At a chemical level the emotions flow through the body based on this system of body/ chemical communication.  Electrical impulses are then sent back through the nervous system to the brain in a loop effect[23].  

We will be conducting a study on both the short and long term impacts on recovery from various mental illnesses.  We still need to determine which baseline assessment(s) to use, as well as assessments on how recovery is impacted.  We expect to do follow ups at six months, one, two, and three year intervals. 

Those individuals who do find Sound Therapy unpleasant (generally less than 2 %), they will be referred to a CranioSacral practitioner for an initial session.  CranioSacral therapy developed by Dr. Upledger, of the Upledger Institute, uses a combination of manipulative and vibrational techniques to increase the production and flow of the fluid that flows between the brain and spinal column. 

LYMPH DRAINAGE MASSAGE

Evidence exists that Lymph Drainage Massage[24] helps to reduce the amount of toxins in the body.  This is particularly important for individuals who have a history of substance abuse.  When lymph circulation slows down waste products can accumulate and stagnate.  This affects normal metabolism and produces a feeling of fatigue.  Lymph massage accelerates the flow of lymph, helping to rid the body of toxins and waste materials.  Lymph Drainage Massage promotes balance of the body’s internal chemistry, purifies and regenerates tissues, helps to normalize the functions of organs, and enhances the function of the immune system.

We expect to make lymph drainage massage, by a licensed massage therapist, available to our formal clients.  It is likely that no more than two lymph drainage massages per year per client will be required.

OTHER VIBRATIONAL (OR A/C) THERAPIES

There are many Vibrational (or A/C) therapies, just a few of which are presented in the appendix.  From time to time, we expect to bring in practitioners of these various therapies to give talks and demonstrations.  When we believe a client may be helped by one of these modalities, we may suggest it to the individual.

FINANCIAL

While a detailed financial plan is still in the early stages of completion, the ballpark estimate is $250,000 a year, increasing to about $450,000 as we add more qualified staff and increase the number of clients we can adequately serve to 50-55.  This would include assistance towards an initial chiropractic examination and / or CranioSacral therapy.  We hope that Medicaid/ Medicare / private insurance will be available for clients to complete these important therapies.  At a later date this policy can be revisited.

KEY PEOPLE

Bob Bennett, author of Mental Illness A Guide to Recovery, will be the Director.  Bob was awarded Advocate of the year in 2007 by The National Association of Peer Specialists, has written a column, primarily on mental health issues, for The Nevada Observer for 3 years, and served from 2001 to 2007 on the Mental Health Planning and Advisory Council for the State of Nevada.  He was awarded Honorable Mention from The Pacific Research Institute (1992) for a paper he wrote on how Mental Health Courts could save communities money while providing better treatment, and served on Judge Breen’s committee which helped to form Nevada’s first Mental Health Court.  He has also given presentations around the country on various topics, including Alternative and Complementary Treatments.  He is also qualified to perform Sound Therapy using tuning forks.

Rosalie Henry, LMT Specializes in Lymphatic Drainage Therapy (LDT)

Nationally Certified Massage Therapist, licensed and practicing bodywork in Reno, NV, Rosalie is a graduate of Ralston School of Massage in Reno, NV.  She began studying massage at East-West College of Healing Arts, Portland, OR.

Continuing education modalities include:

Lymphatic Drainage Therapy - Advanced (Upledger Institute)
Neuro-Muscular Therapies (Spinal Touch)
Ortho-Bionomy
Sound Therapy using Tuning Forks - Advanced
Touch for Healing
Unified Field Therapy
WatPo Thai Foot Reflexology, (Bangkok)

During a session, Rosalie may employ a combination of techniques from her "toolbox" of "gentle, effective modalities", lymph, neuromuscular and positional release therapies.  These facilitate body-mind communication.

Rosalie support clients with both touch and non-touch therapies, which enables her to work pre and post surgery, injury, as well as basic needs for relaxation, stress reduction, rejuvenation, and pain reduction.

The Nevada Disability Advocacy Law Center, including its Board of Directors, will provide overall guidance and direction.  

OBSTACLES AND CONCERNS

By locating the facility near downtown Reno, or along the Fourth Street or Virginia Street corridors, the NIMBY concerns would be lessened, as well as making it easier for clients who depend on buses.  However, should a facility or building become available elsewhere, it would be seriously considered, particularly if it has adequate bus service.

For many years, prescription drugs have been the main, and often the only therapy for individuals who have received a mental health diagnosis.  There may be those who will fight efforts to make recovery holistic, despite The National Consensus Statement on Mental Health Recovery from SAMHSA.

Nevada Medicaid only pays $1.57 for each 15 minute segment of group mentoring per individual and only $7.58 for each 15 minute segment of individual mentoring.  There is also a twenty hour per year limit placed on the amount of peer mentoring that will be reimbursed.  Our program will require greater amounts of peer mentoring, although over a more compacted time frame. 

Medicare does not currently pay for peer mentoring.  Other sources of funding will be required to maintain the program.

Many of the alternative/ complementary therapies often result in increased energy for the recipients.  For this reason, these therapies generally won’t be started until the client has begun Recovery: A Path for Difficult People, to minimize the possibility of the misdirection of this energy.

We will require one or two graduate students who will have the main task of documenting our clients’ recovery for purposes of scientific research, and publication of results.  Discussions will need to be held with these students, as well as faculty advisors, on various topics, including value of recovery for individual and community versus demands of the scientific research.  Individuals need to feel they have been treated with dignity and respect, that they are more important than the paperwork.      

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