Yale Psychiatry Grand Rounds: October 6, 2023

Transcript

• 00:00So good morning, everyone.
• 00:02Just a second. My name is Annie Harper.
• 00:06I'm the now the director of the
• 00:08Citizenship Community Collaborative,
• 00:09which we call CCC since
• 00:11Michael retired in December.
• 00:12Big shoes to step into.
• 00:14I'm also direct director of the
• 00:16financial health work we do here.
• 00:18And firstly, I want to stay on
• 00:19behalf of the director of Perch,
• 00:20Doctor Sherrell Bellamy,
• 00:21who's with us today,
• 00:22and the Perch leadership,
• 00:23faculty, staff and collaborators.
• 00:24We so appreciate you all being
• 00:26here today to honor the work of
• 00:28Michael and all the scholars that
• 00:29have been influenced by his work on
• 00:31citizenship and community inclusion.
• 00:32It's really an amazing experience
• 00:34to be part of something that's
• 00:36making such a difference around
• 00:37the country and around the world.
• 00:39So my personal involvement in this
• 00:41work started when I met Michael,
• 00:43maybe 10 years ago or so,
• 00:45introduced to him by our own
• 00:47dear colleague and person I
• 00:49call Master of Connections.
• 00:50Kyle Peterson.
• 00:51And Michael saw the role that I,
• 00:53as a cultural anthropologist who
• 00:55studies money and financial systems,
• 00:56might play a mental health
• 00:58research and practice.
• 00:59I have no knowledge of health or
• 01:01healthcare and really still don't.
• 01:03But Michael understood that if
• 01:04we take the social or structural
• 01:06determinants of health seriously,
• 01:08we need to be working across
• 01:10boundaries to really understand and
• 01:11address the determinants that have
• 01:13such a profound impact on the mental
• 01:15health and wellbeing of so many.
• 01:16Michael recognized the value of my
• 01:18understanding of the ways that our
• 01:20economic and financial systems work.
• 01:21All very often don't work for people,
• 01:24particularly people who are
• 01:25poor and have mental illness.
• 01:27And this,
• 01:27for me is the heart of the
• 01:29citizenship approach,
• 01:30recognizing that very often the problems
• 01:32that we grapple with around mental illness,
• 01:34and thus the solutions,
• 01:36lay far outside our biology,
• 01:38our bodies,
• 01:38our brains,
• 01:39and indeed the clinics where we
• 01:41where we usually treat the problems.
• 01:43So as far as my financial health
• 01:45is concerned,
• 01:45with the support of Michael and the CCC team,
• 01:47we've developed a financial health
• 01:49program that explores what we
• 01:50need to be doing differently.
• 01:51And by we,
• 01:52I don't mean just us who work
• 01:53in mental health,
• 01:54but we as a society and specifically
• 01:56the financial services industry,
• 01:58what that needs to be doing
• 02:00differently to make sure that
• 02:01everyone can be financially healthy.
• 02:03And this includes people who may
• 02:05sometimes need help managing their money.
• 02:06And actually that's all of
• 02:08us probably at some point.
• 02:09This is not just a mental health problem,
• 02:11you know, mental health, For example.
• 02:13In financial health work,
• 02:14we're exploring ways to make sure
• 02:15that people with mental illness
• 02:17who've been incarcerated aren't facing
• 02:18financial problems that get in the
• 02:19way of their recovery and their reentry.
• 02:21We're exploring what we can do
• 02:22to ensure that people who do need
• 02:24someone to help them manage their
• 02:25money have the options they need
• 02:27to ensure they can do that with
• 02:29the maximum dignity and autonomy.
• 02:31One of the amazing things about the
• 02:33citizenship approach and working in
• 02:35this place is that it insists that
• 02:36we don't get stuck in our own silos.
• 02:38So my focus is finances,
• 02:40but that's never all I'm working on.
• 02:42I'm constantly engaging with colleagues
• 02:43who address other parts of life,
• 02:45which are all related.
• 02:47A few of those are listed,
• 02:48if you go to the next slide
• 02:54on a few of them are listed here,
• 02:56from learning collaborative training
• 02:58providers around the state of
• 03:00Connecticut all the way to the
• 03:01to the music theatre and magic,
• 03:02the work that we've done
• 03:04and they're still doing.
• 03:05The Citizens Project listed here is
• 03:07the most longstanding program of the
• 03:08citizenship work and the foundation of
• 03:10almost everything that's come afterwards.
• 03:12My colleague at Perch, Betty Benedict,
• 03:14has led that work for years,
• 03:15and we'll hear later from Bridget Williamson,
• 03:17also from Perch, who's currently
• 03:19director of the Citizens Project.
• 03:21Bridget and another colleague from Perch,
• 03:22Billy Bromage,
• 03:23will talk about the incredible work.
• 03:24They do engage in community doing,
• 03:26community organizing,
• 03:27and really addressing through
• 03:29advocacy the policy level,
• 03:30structural determinants of health.
• 03:32And we'll hear from other colleagues at CMHC
• 03:35who've been influenced by Michael's work,
• 03:36Erica Carr and Allison Ponce.
• 03:39Then we'll hear from people across the globe.
• 03:40Jean Francois Paletier from the
• 03:43University Of Montreal in Canada.
• 03:45I'm going to mess up the name,
• 03:46but I'll do my best.
• 03:47Francisco Aroa Arosa from the
• 03:49University of Barcelona in Spain,
• 03:51Fiona Wong from the Richmond
• 03:52Fellowship in Hong Kong,
• 03:54and Gillian McIntyre from the University
• 03:55of Strathclyde in in Scotland.
• 03:57This is really just the beginning of
• 03:59the citizenship work and Michael's
• 04:01work has laid this foundation for us.
• 04:03And we will hear a bit more
• 04:05from Michael at the end.
• 04:06So I'll pass it on now to Fran.
• 04:07And I hope,
• 04:08Fran,
• 04:08you have time to do this before you
• 04:10have to leave to pick up your children.
• 04:12Thank
• 04:12you, Annie. Well, so in my presentation,
• 04:16we'll have five parts.
• 04:17It's going to be short,
• 04:18but I'm going to talk a little bit
• 04:20about discrimination history, measure,
• 04:21training and finally citizenship.
• 04:24So next, I guess. Yeah.
• 04:29So when I met Michael and and I
• 04:32listened to to his work and and so
• 04:35Larry Davidson and everything that had
• 04:37to do with recovery and relationship.
• 04:39I wondered what makes the people you
• 04:41can see on the left to the people that
• 04:44you can see on the right that supposedly
• 04:47also had a mental health problems
• 04:50during their lives and I said okay,
• 04:52it's a question of power.
• 04:55So why I need to to tell a history
• 04:58to myself about how this connects to
• 05:01with the history of mental health,
• 05:03mental health care.
• 05:04So I did this graph that I used to
• 05:09explain recovery and citizenship
• 05:11to to people here in Spain.
• 05:13And basically I understood that we
• 05:16started treating people from our
• 05:19custodial system and then we we
• 05:21changed to trying to heal people,
• 05:23trying to rehabilitate, rehabilitate people.
• 05:25And then the recovery model
• 05:29appeared. And then how does that connect
• 05:32with citizenship, which is next,
• 05:35not next, not an alternative to recovery,
• 05:40with something that in my opinion at
• 05:43least gives context and a political
• 05:46background to the recovery model.
• 05:48Yeah, it's here's a paper by Larry Davidson
• 05:52and Michael Rowe that is recovering this
• 05:54relationship that can give you some tips.
• 05:57So the first thing that I
• 05:59wrote and that was the plan.
• 06:02So what I will be doing when I go to funding,
• 06:04what I will be doing the next year with
• 06:06Michael Rowe, and this is the paper.
• 06:11So why I I planned 33 phases.
• 06:15In each of them there was a preparation
• 06:18and involvement and an evaluation phase.
• 06:20I started by no, don't go back, please.
• 06:25Yeah, So I started searching for
• 06:27well established models and I
• 06:29found recovery and citizenship and
• 06:31I I found internationalized and
• 06:36I did focus groups and interviews
• 06:39with stakeholders in Spain.
• 06:41We did an its assessment and we
• 06:43elaborated some measurement instruments
• 06:44designed and support and professional
• 06:46training activities and measure
• 06:48the impact of these activities.
• 06:49And now we are currently in the third
• 06:53phase in in which I am trying to
• 06:58give some inputs to the citizenship
• 07:00model at a policy making level.
• 07:02I was recently at the Parliament of Catalonia
• 07:05and I'm in some advisory bodies next.
• 07:10This is the measure we did is a Beliefs
• 07:14and Attitude Mental Health Scale,
• 07:15which measures some beliefs
• 07:17and attitudes that are related
• 07:18with recovery and seditionship,
• 07:20and how mental health professionals
• 07:22connect with these attitudes and beliefs.
• 07:24It's validated and you can download
• 07:26it for free in this journal,
• 07:29and it was used to measure the
• 07:31impact of our activities with
• 07:32mental health professionals. Next,
• 07:37the dimensions.
• 07:38You can see in the screen the
• 07:40dimensions of this measure system
• 07:43criticism, justifying beliefs,
• 07:45freedom versus coercion,
• 07:47empowerment versus parallelism,
• 07:49and next tolerance versus discrimination.
• 07:54We also did a systematic review of
• 07:57meta analysis of recovery educational
• 07:59interventions to see what people
• 08:02had done before us and we saw
• 08:04that there were positive results
• 08:06for for beliefs and attitudes.
• 08:08So recovery oriented training
• 08:11activities during the 90s and the
• 08:142000s had a an impact on over the
• 08:18release and attitudes of professionals,
• 08:19but it was not so clear for recovery
• 08:21based practice as you can see in the
• 08:23graph in this final plot on the right next.
• 08:28Thanks to this review,
• 08:30we were able to design and implement
• 08:33continuing education activities for
• 08:36mental health professionals and also
• 08:39training for training for the trainers
• 08:41of peer support that is now currently
• 08:45being carried out in Catalonia.
• 08:47So we are starting to carry to train our
• 08:50first peer support workers here in Catalonia.
• 08:53Next and this is the results of
• 08:58the evaluations of this recovery
• 09:01oriented recovery and rights based
• 09:05oriented activities with a class of
• 09:07randomized weightless control trial.
• 09:09And we saw that there was,
• 09:11there were positive results
• 09:13especially for coercion.
• 09:14So our training activities decreased
• 09:18the beliefs that coercion or coercive
• 09:21practices are good in in mental health.
• 09:25This was done with more than 500 mental
• 09:29health professionals and next and now we
• 09:32are starting to design and implement.
• 09:35Also this is now 2019,
• 09:39some training activities that
• 09:41are purely based on citizenship.
• 09:43On the citizenship model,
• 09:44this is one thing that we use.
• 09:46We use this thing,
• 09:47this table that you can find on the right.
• 09:50So we make students participants,
• 09:54analyze the places they work or they do
• 09:59internships or whatever in terms of rights,
• 10:02responsibility in terms of the five hours,
• 10:03rights,
• 10:04responsibilities, roles,
• 10:05resources and relationships.
• 10:06Elements to highlight part of
• 10:08the program where they work,
• 10:09that they believe they already deal
• 10:11with this dimension of citizenship.
• 10:14And all the other elements that
• 10:15should be reflected on part of the
• 10:17program that we believe it could be
• 10:19modified to deal with the dimension
• 10:21of the citizenship more deeply.
• 10:23Next and now we are going to carry out
• 10:29another randomized trial of awareness
• 10:30interventions for mental health
• 10:32professionals based on the solution model.
• 10:34This is what we are currently doing.
• 10:35This paper is from this year
• 10:38in this back back please.
• 10:43So to finish,
• 10:46to wrap up in this, in this the,
• 10:50the message is that instead of
• 10:52treating aspects of the citizenship
• 10:53as determinants of mental health,
• 10:55that is already the case,
• 10:56but without a clear impact on
• 10:58changes in the care model.
• 10:59Our can you go back,
• 11:00please?
• 11:03Our proposal is to treat citizenship
• 11:04as the main outcome of any mental
• 11:06health intervention and treat
• 11:07psychopathology as one among
• 11:08many others of its determinants.
• 11:10Thank you.
• 11:11And I am going to turn it over to John Hasso.
• 11:16Thank you.
• 11:19Thank you, friend. Thank you, Michael.
• 11:22Nice to meet you all today.
• 11:25My name is Jean Francois Peltier.
• 11:27You can tell it's a French name.
• 11:29I live in Montreal, Canada.
• 11:31I'm an assistant clinical professor at Yale,
• 11:34and I'm also a clinical researcher
• 11:38at the Integrated Health and Social
• 11:41Services Center in West Montage.
• 11:43This is on the South Shore Of Montreal.
• 11:47You see here the the colored sections of
• 11:52this huge agency in the province of Quebec.
• 11:56We have 16 regional authorities and this
• 12:00is one of them to cover the territory.
• 12:03And we have about 500,000 inhabitants
• 12:07and more than 10,000 employees.
• 12:10So it's a big area and now
• 12:13I'm a clinical researcher,
• 12:15I'm still affiliated with the university,
• 12:18but more more more importantly,
• 12:21I'm really into the system as a clinical
• 12:25researcher and I'm also been affiliated
• 12:28to purge for more than 5015 years now.
• 12:31And my background is in
• 12:33the political science,
• 12:34so citizenship and political for
• 12:37political sciences scientists of
• 12:39course it's it makes a lot of sense.
• 12:41And what I want to present to you
• 12:44Michael today is that I think we,
• 12:46we made the great,
• 12:48great progress into that very public
• 12:51mental health system and and addiction.
• 12:54So I'm a peer,
• 12:55I'm a peer support worker too.
• 12:57And the next slide please.
• 13:01So this is the structure of the
• 13:05Sismo integrated.
• 13:06It's a service in Monte Regi West
• 13:09so that makes Sismo Okay that
• 13:11this greater big organization.
• 13:14We have mental health on one
• 13:17side and addiction on the other
• 13:19side and with about
• 13:23500 full time equivalent employees
• 13:27for mental health and addiction
• 13:30and I'm for the both mental health
• 13:32and addiction. Next slide please.
• 13:36So we are. I'm a peer support worker.
• 13:40For support workers,
• 13:41our person with first hand lived
• 13:43experience of mental health or addiction
• 13:45problems and who are further along
• 13:48in their own recovery journey and
• 13:50we can provide supportive services.
• 13:52And what we did that this agency is
• 13:54that all peer support workers will be
• 13:57using the citizenship measure combined
• 13:59to the recovery assessment scale.
• 14:01And this is really a first,
• 14:03it's a official clinical tool.
• 14:06Okay. Next slide please.
• 14:11And we started to the development of
• 14:14the citizenship measurement several
• 14:16years ago and we translated it in
• 14:19French into French, French Quebecois.
• 14:21As you know, Canada is a bilingual country,
• 14:25but there is no such things as
• 14:28a one Canadian health system.
• 14:30We have 10 provinces,
• 14:32so there are 10 provincial health
• 14:34systems in the province of Quebec,
• 14:37it's in French and also we have in Montreal.
• 14:40It's also we have an English
• 14:42speaking community,
• 14:43but we translated with Michael
• 14:46the citizenship measurement into
• 14:48French and it has been evaluated,
• 14:51it's validated.
• 14:52So we have a combination of
• 14:54the citizenship measurement,
• 14:55the recovery assessment scale.
• 14:57Both have have been validated in French
• 15:00and in English and you see there the,
• 15:02the,
• 15:02the current backs here,
• 15:03Next slide please.
• 15:07So when we did this validation,
• 15:09we combined the two tools,
• 15:10the Ras and the CM and that makes a 47 item
• 15:17measurement of personal civic recovery.
• 15:19That's the name we chose and you see
• 15:22below for clinicians with us today,
• 15:24you will recognize classic
• 15:26clinical tools that are used in
• 15:29clinical settings by clinicians.
• 15:31Those tools were designed
• 15:33by clinicians and academics.
• 15:35That's fine.
• 15:36But the recovery assessment scale
• 15:38and the citizenship measurement were
• 15:40developed too with service users and
• 15:43by service users for service users.
• 15:46And the next slide please.
• 15:49We've been able with the the
• 15:52department of the medical archives,
• 15:55we negotiated to have this tool
• 15:58really to be used on a regular basis.
• 16:03This is more and we have a
• 16:07received two days ago the number,
• 16:09the number of that tool is
• 16:14606522. That's the number of the beast.
• 16:16OK, so it's really important we
• 16:19have a first official clinical
• 16:22tool in the public system for peer
• 16:25support workers to have something
• 16:26that is really reserved for them.
• 16:29Other conditions have their
• 16:31own reserved act and tools.
• 16:34And now we will be using this combination
• 16:36of the citizenship measurement with
• 16:38recovery assessment scale to guide
• 16:40and define the peer support workers,
• 16:42individual and group interventions.
• 16:44And there's a typo here.
• 16:46It's really to write,
• 16:48to write evolutionary notes to
• 16:50the medical record of our service
• 16:52user that will be supported
• 16:54by the peer support workers.
• 16:57So Michael,
• 16:58I think you will be happy to see
• 17:01the big opportunity we have here.
• 17:04This opens the way to multiple
• 17:07research projects,
• 17:08including longitudinal studies and
• 17:10in combination with other sources of
• 17:14data provided by the public system.
• 17:16So we for example,
• 17:18we might we might want to come
• 17:20back in 1520 years from now.
• 17:23Do the service users that were
• 17:26supported by peer support workers who
• 17:28use the combination of the citizenship
• 17:31measurement and recovery assessment scale,
• 17:33can we see some changes over time,
• 17:36not just at six months or 12
• 17:39months but maybe up to 20 years.
• 17:41Do we see different service use
• 17:44medication and things like that And
• 17:47and those data will be provided by
• 17:50the public system not by the the,
• 17:53the, the,
• 17:53the add on from the academic research.
• 17:56And so it will become really
• 17:59mandatory for peer support workers
• 18:01to use this new clinical tools,
• 18:04clinical tool.
• 18:04And to our knowledge,
• 18:06I think it's the first certainly in Canada,
• 18:09maybe North America that we do
• 18:11have with the public system,
• 18:13an official clinical tool reserved
• 18:15for peer support workers.
• 18:17And that tool is a combination of
• 18:20the citizenship measurement and
• 18:22the recovery assessment scale.
• 18:24That's it for me. Thank you.
• 18:25Now I passed the mic to my colleague
• 18:28and friend Gillian for Scotland.
• 18:33Thank you JF. Hi everyone,
• 18:35and my name is Jillian McIntyre and
• 18:38I'm here to talk to you about the
• 18:41citizenship work that has been taking
• 18:44place in Scotland over the last few years.
• 18:48In our work with Michael and Perch
• 18:50began in 2014 and at that point
• 18:53we were lucky enough to receive
• 18:55funding from Horizon Europe.
• 18:57That was at the point in time when
• 19:00Scotland was technically still in Europe
• 19:02to fund an exchange between researchers,
• 19:04policymakers, practitioners and
• 19:06people with left experience.
• 19:09And that facilitated a number
• 19:12of exchange visits between
• 19:14Scotland and colleagues at Yale.
• 19:17And this allowed us to carry
• 19:18out a whole range of activities,
• 19:20including developing research projects,
• 19:23joint supervision of PhD studentships,
• 19:26hosting conferences together
• 19:28and producing joint papers.
• 19:31In next slide please gratsy.
• 19:34I want to focus though today on the
• 19:37production of the Scottish Citizenship
• 19:39model and measure and because this
• 19:41is a piece of work that we are
• 19:44particularly proud of in Scotland,
• 19:47we were we received additional
• 19:49funding to carry out this work
• 19:51from Turning Point Scotland,
• 19:52Scottish Recovery Network and the
• 19:54Health and Social Care Alliance.
• 19:57And so as you can see from the slide,
• 19:59this work has been fully written up and
• 20:01published and with a number of papers.
• 20:03And this one he does from health
• 20:05and social care in the community and
• 20:07and this slides he outlines that the
• 20:10key stages that we went through to
• 20:12replicate exactly the work that had
• 20:15been carried out and perched to develop the.
• 20:17The citizenship and model and measure.
• 20:21So we carried out a number of
• 20:23focus groups with those who had
• 20:25experienced life disruptions to ask
• 20:26what citizenship meant to them,
• 20:28and we then analyzed that data
• 20:30to generate over 100 statements
• 20:33on citizenship and then asked
• 20:35participants to manually sort these
• 20:38using a process of concept mapping.
• 20:41We then went on to carry out
• 20:43Multidimensional scaling and cluster
• 20:45analysis and that helped us to produce
• 20:48a model of citizenship for Scotland.
• 20:50And if we move to the next slide
• 20:53Scratchy we can see here this is
• 20:56the representation diagrammatically
• 20:58of the Scottish citizenship model.
• 21:01And and if we move straight to the
• 21:04the next slide we can see that the
• 21:07the Scottish model of citizenship
• 21:09followed very closely and and and has
• 21:11a lot of similarities with the the
• 21:145R's and and the the United States
• 21:16and it has five core clusters which
• 21:20are around building relationships
• 21:22acceptance and autonomy access to
• 21:24services and support shared values
• 21:27and social roles and civic rights
• 21:30and responsibilities.
• 21:31And I think what was really important
• 21:33about our model of citizenship
• 21:35was the the significance of the
• 21:37relational component of citizenship
• 21:39that came out really,
• 21:40really strongly in the Scottish
• 21:42context and that was seen as
• 21:44particularly important in terms of
• 21:47developing inclusion and a sense of
• 21:49belonging for our participants in.
• 21:52From there we went on to develop a
• 21:54psychometrically sound measure of
• 21:56citizenship and that's a 39 item measure.
• 21:58And again that's been written up and
• 22:01published in health and
• 22:02social care in the community.
• 22:04And my colleague, Dr.
• 22:05Nicola Cogan, who's on the call in late on,
• 22:09on that that piece of work.
• 22:11And that really is a tool that can
• 22:13be used across health and social
• 22:15care settings as well as in research
• 22:18contexts to facilitate conversations
• 22:20around citizenship as well as to
• 22:23measure progress around particular
• 22:25aspects of citizenship that are important
• 22:28to people with lived experience.
• 22:31So if we move on now,
• 22:32gratsy, thank you.
• 22:35But I think it's also important I
• 22:37want to highlight that the work of
• 22:39citizenship in Scotland moves beyond
• 22:41purely the academic and it has had a
• 22:44really significant role to play and
• 22:46practice across Scotland as well.
• 22:48Just want to highlight an example
• 22:50of this with our partnership
• 22:52with Turning Point Scotland.
• 22:54And that work has been led by our
• 22:57colleague Karen Black and Citizenship.
• 22:59And Michael's work there has been
• 23:01fundamental in terms of the development of
• 23:04services and support within Turning Point.
• 23:06And as an organization,
• 23:08their whole ethos and strategy
• 23:10is now underpinned by Citizenship
• 23:12as an approach and a philosophy.
• 23:15And I think it's a really
• 23:17brilliant example of good practice.
• 23:19And next slide please,
• 23:21please Gratsy,
• 23:22just to highlight very briefly that
• 23:23all of the work that we've we've
• 23:26undertaken in Scotland has been
• 23:28underpinned by peer research and
• 23:30working in close partnership with
• 23:31people with with lived experience.
• 23:33And this is a group of our peer
• 23:36researchers here in in this
• 23:37photograph on on the slide,
• 23:39we've learned an important number of
• 23:41important lessons about the importance
• 23:43of spending time with people.
• 23:45And you're thinking about
• 23:47practicalities and value in the
• 23:49contributions that that people make.
• 23:51And in that respect with land.
• 23:52A huge amount from the from Michael's
• 23:55work and the work of colleagues at Perch.
• 23:57So I want to finish by moving
• 23:59to the next slide.
• 24:00And initially just to give you
• 24:02a sense of the impact that
• 24:04Michael's work has had in Scotland,
• 24:06both on a personal and a professional level.
• 24:09And I want to finish by with a
• 24:11quote from my colleague and Dr.
• 24:13Kirsten McLean and who said Michael
• 24:15believed in me and I will be
• 24:17forever grateful that I had the
• 24:20incredible opportunity to go to Yale.
• 24:22I will always cherish the experiences
• 24:24and immersing myself,
• 24:25myself and Michael's work on citizenship,
• 24:28the ripple effects of which will be
• 24:30failed in so many people's lives
• 24:33for years to come.
• 24:34And I think that really encapsulates
• 24:36our thoughts across Scotland.
• 24:38So thank you,
• 24:39Michael and I'll now pass on to
• 24:41our colleague Fiona.
• 24:48Thank you. Hi, good morning everyone.
• 24:50My name is Fiona, representing
• 24:53Richmond Fellowship of Hong Kong.
• 24:55We are in non government organization
• 24:57providing community mental health services.
• 25:00So today I'm going to outline the milestones
• 25:03and talk about how Richmond Fellowship
• 25:06implement recovering citizenship in
• 25:08the services and programs this piece.
• 25:12In 2019 we had already
• 25:15started some preparation work.
• 25:171st, we conducted a focus group to study
• 25:20the views and concerns of our staff.
• 25:22If we were going to use the concept
• 25:25of recovering citizenship in our
• 25:27services so that we could prepare
• 25:30earlier and it it is not surprised that
• 25:32we find that our staff had limited
• 25:35understanding on recovering Citizenship
• 25:36and would like to have more guidance.
• 25:39Therefore,
• 25:40now we are providing Recovering Citizenship
• 25:42workshop to all new staff to ensure
• 25:45that at least they have a fundamental
• 25:48understanding of recovering Citizenship.
• 25:50And second,
• 25:51as we plan to use the citizenship measures
• 25:54in the Citizens project and casework,
• 25:57we developed the Chinese version
• 25:59by translating the original 1 into
• 26:02Chinese and conducted reliability test.
• 26:05So the findings have been submitted
• 26:07to a journal for publication.
• 26:10Next please.
• 26:12And in January year 2020,
• 26:14we have six staff members at 10
• 26:17training as Yale Persh learning
• 26:19how to run the Citizens project.
• 26:23Next please.
• 26:25So starting from October 2020 till now,
• 26:28within these three years,
• 26:30we have delivered six Groups
• 26:32of Citizens project.
• 26:33For the first five groups,
• 26:35we have 40 students graduated and
• 26:39group 6 will be completed soon
• 26:41around late October this year.
• 26:44And in order to sustain the project,
• 26:46we have trained 18 facilitators,
• 26:49including peer support workers,
• 26:51occupational therapists and social workers.
• 26:54So the citizens project will continue as
• 26:57a regular service in our organization.
• 27:00Next, please.
• 27:03So when we talk about community integration,
• 27:06I think it is important to know
• 27:09how the community community look
• 27:11at recovering citizenship.
• 27:13Therefore, in year 2021,
• 27:14we conducted a phone survey to
• 27:17investigate the knowledge and attitudes
• 27:19of the community toward recovering
• 27:22citizenship and mental illness.
• 27:24So this paper has been published on
• 27:27the Journal of Public Mental Health.
• 27:29We interviewed 1009 people and we
• 27:33found that the general population
• 27:35has good knowledge of mental health
• 27:38and around half had heard about
• 27:40the basic concept of recovering
• 27:43citizenship and 79 to 94% agree
• 27:46that people in recovery should
• 27:49process the five hours next piece.
• 27:55And in May 2022, because of the COVID,
• 27:59we were unable to hold our
• 28:02conference physically.
• 28:03Therefore, we have a webinar
• 28:05instead on recovering citizenship,
• 28:07and we were glad to have Professor
• 28:09Michael Rowe to be our keynote
• 28:11speaker to talk about the recovering
• 28:14citizenship approach in mental health.
• 28:17And on the other hand,
• 28:18in the webinar our colleagues also
• 28:20share their their experience in local
• 28:23implementation of recovering citizenship.
• 28:26And in this webinar we have more
• 28:28than 300 people participate.
• 28:31Next piece.
• 28:35This one shows that we created a board
• 28:38game kit on recovering citizenship for the
• 28:42promotion in the community. Next piece.
• 28:48So besides developing the
• 28:50Chinese citizenship measures,
• 28:52currently we are also power testing
• 28:55the the citizenship measures beef,
• 28:57the one with 12 items.
• 28:59We want to see if it can be used
• 29:02as an interviewing tool for new
• 29:05cases in community setting.
• 29:07And we also encourage our colleagues to
• 29:10emphasize the elements of the five hours
• 29:13when running programs in the community.
• 29:15So here are two examples.
• 29:17One is the one is called the
• 29:21Environmental Volunteers program.
• 29:22In this program,
• 29:24the participants help sorting out
• 29:26garbage which can be recycled.
• 29:29Another one is called another
• 29:30program is called
• 29:34dormitory. So in this program
• 29:36the participant need to arrange
• 29:38visits to those residents who
• 29:40live in our halfway houses
• 29:42before but have gone back home.
• 29:45So by participating in
• 29:47this community programs,
• 29:48the roles and responsibility in
• 29:50the community can be enhanced
• 29:52and and the participants can
• 29:55also develop and establish
• 29:56relationship with other people.
• 30:01Next please and in December this
• 30:04year we will hold an international
• 30:06mental health conference.
• 30:08The main theme is mental Wellness,
• 30:10recovering citizenship.
• 30:11So we are very honored to have
• 30:14Professor Michael Rowe to give a
• 30:17keynote speech on recovery citizenship,
• 30:19Miss Mary O'hagan from PSO New Zealand
• 30:21to talk about collaboration and Professor
• 30:24Samson said from University of Hong
• 30:26Kong to talk about strength based care.
• 30:29Also, we have also invited Miss Patty
• 30:33Benedict and Doctor Helen Emma from the
• 30:35Yale Perch to be speakers of the conference.
• 30:38So thank you very much for all
• 30:40your support of the conference.
• 30:42And in the coming years,
• 30:43we will continue the citizens project
• 30:46as a regular service trying to
• 30:48make it more localized and to train
• 30:50the graduates to be facilitators.
• 30:52And we will continue incorporating the
• 30:55five hours concept into our services
• 30:57and programs and to promote our see,
• 31:00I mean the recovery,
• 31:02citizenship across community stakeholders.
• 31:04So this is the end of my presentation.
• 31:06Thank you very much.
• 31:07And now I'm going to turn it to Erica.
• 31:10Thank you.
• 31:12Hi.
• 31:12So I'm Erica Carr and I might yell
• 31:15Connecticut Mental Health Center.
• 31:16And today I get the pleasure of
• 31:19and just extreme honor of talking
• 31:21with this talented group of people
• 31:23about citizenship and how that
• 31:25relates to inpatient settings.
• 31:26I know this is very different to think about,
• 31:29but I I think also never is more
• 31:32important than when you think
• 31:33about the fact that people have
• 31:36to sometimes go within inpatient
• 31:38settings and a door is locked on them.
• 31:40So I'm going to talk about using positive
• 31:42behavioral supports as a means to gain
• 31:44citizenship from behind those locked doors.
• 31:47And positive behavioral supports is
• 31:49basically a way of managing challenging
• 31:51behaviors that sometimes occur on
• 31:54inpatient settings with non punitive,
• 31:56non coercive methods.
• 31:57So our idea is basically trying to
• 32:00understand why do these behaviors
• 32:02occur in these settings and it's it's
• 32:05very interesting and why they occur.
• 32:06I think it a lot of it relates to the
• 32:08fact that it's an artificial environment.
• 32:10It's not like the real world,
• 32:12right?
• 32:12You you're not really a citizen there
• 32:14in many ways because your rights have
• 32:16been stripped from you in many ways.
• 32:18If you've been involuntarily hospitalized,
• 32:20you may be involuntarily medicated as well.
• 32:23So it's a it's a very unusual
• 32:25environment people find themselves.
• 32:27So we want to understand why
• 32:29challenging behaviors occur,
• 32:31teach new skills that for the individuals
• 32:34they can communicate effectively.
• 32:35But just as importantly or more importantly
• 32:37understand ecologically what is going
• 32:40on and what is the environment need
• 32:42to do so that that skill isn't needed.
• 32:45And that speaks I think hugely,
• 32:48is that there's something about
• 32:50the environment.
• 32:51A lot of times it brings up these behaviors.
• 32:54Next slide please.
• 32:56So how does this map onto the
• 32:58ideal of citizenship?
• 33:00PBS at its core is the idea
• 33:02that we want everyone to have a
• 33:04meaningful life and that we want
• 33:06it to be very person centered.
• 33:08Avoid.
• 33:28I think Erica froze.
• 33:29The fact that they want to they
• 33:32want to have a girlfriend again.
• 33:34They want to go back to work.
• 33:35They want to go back.
• 33:47Hopefully she'll be able
• 33:48to get back on with us.
• 33:49I'm going to start off.
• 33:52We're honored to be here today
• 33:54to talk about Michael's inspired
• 33:56so many of us in so many ways.
• 33:58So we're going to talk a little bit about
• 34:00some of the applications of citizenship
• 34:02here in New Haven that we've worked on.
• 34:05Collective citizenship was defined in
• 34:07a 2019 paper by Michael and colleagues
• 34:10as a response to the individualizing
• 34:12tendency of mental health services.
• 34:14In collective citizenship.
• 34:16Power belongs to the group,
• 34:17not to the service providers.
• 34:19To dole out, service providers must
• 34:22earn trust as common cause partners,
• 34:24not automatically assume the role of leader.
• 34:27This requires A deliberate,
• 34:29often challenging power shift in
• 34:32power from service providers.
• 34:342 people in recovery as valued
• 34:36community members,
• 34:37not as disempowered or socially
• 34:39isolated patients or clients.
• 34:41It requires intentional solidarity.
• 34:42And I'm going to turn it over to
• 34:44Bridget to talk a little bit more
• 34:46about our approach.
• 34:48Thank you.
• 34:51Thank you so much.
• 34:52My computer's tripping right now.
• 34:53But however, I just think it's very
• 34:57important that we literally come outside
• 35:00he was because a lot of times when we
• 35:04going to the agencies that we only spend
• 35:06like 1/2 an hour or hour there or less,
• 35:09we coming back for a group
• 35:10or something like that.
• 35:12But the majority time we are
• 35:13out here in the community.
• 35:15So I just think that the meat
• 35:17and potatoes are out here,
• 35:19we already here.
• 35:20So I just think the key to coming out
• 35:24here is to the into that community
• 35:28because it's so important for us of
• 35:31important how we go into there is to,
• 35:35you know, go in with opening ears
• 35:38and listening because it's not
• 35:42the expertise behind the walls,
• 35:44it's the expertise that's in that community,
• 35:46where they at,
• 35:47because we know how to survive.
• 35:49Not only that,
• 35:50I need folks to know that when we are
• 35:54there or in the community that we are
• 35:57capable of making our own decisions.
• 36:00Like I don't need someone to control my
• 36:03space and drive my car because the best
• 36:06person to drive your car is yourself.
• 36:08So once we teach people how to,
• 36:11you know, move forward,
• 36:13because everything has to
• 36:15be a shared decision,
• 36:17it cannot come from the provider.
• 36:20Again, I'm driving my car.
• 36:22So once we feel hopeful to do that,
• 36:26you basically can get folks
• 36:27to do whatever you want,
• 36:29but do more listening when you're coming
• 36:31to the community than controlling the
• 36:34space and putting in your own agenda.
• 36:36We are very resilient people.
• 36:39And as I move forward in life,
• 36:41I lift people up and bring her with me.
• 36:44I don't leave people behind.
• 36:45I think that's very important.
• 36:49So I'm going to share a little.
• 36:50Thanks, Bridget. I'm going to
• 36:51share a little bit about some of
• 36:53the groups that Bridget and I work
• 36:54with here in New Haven as part of
• 36:56our collective citizenship work.
• 36:58We've been fortunate to work with Focus,
• 37:00Act, Connect every day, or FACE,
• 37:02which is a meeting in coffee shops
• 37:05across New Haven since about 2015,
• 37:07and then we met weekly on Zoom.
• 37:09During the pandemic,
• 37:10the collective operates on Consensus.
• 37:13It's makes it very clear that it is not
• 37:15specifically a mental health group,
• 37:17and it's focused very much
• 37:18on community building,
• 37:19though mutual support around mental health
• 37:21struggles is a key part of the group.
• 37:26Here, Faces, pictured making
• 37:29a coordinating A mural at a
• 37:30neighborhood festival in New Haven,
• 37:32as well as packing groceries at an
• 37:34annual food drive that we do every year.
• 37:36And here in New Haven,
• 37:38we did some qualitative interviews
• 37:40with members of FACE and found
• 37:42that that face gives a strong sense
• 37:45of ownership over the collective.
• 37:47It decreased social isolation
• 37:49against indicated,
• 37:50stronger connections to the community,
• 37:52increased hope and the sense of agency.
• 37:55Witnesses to Hunger,
• 37:56also pictured as a collective of
• 37:58New Haven residents with personal
• 38:00experiences of poverty who organized
• 38:02around Food Insecurity and 2018.
• 38:05We helped get them get started
• 38:09and we've been Bridget,
• 38:11particularly as in bringing members into
• 38:14that group and getting them oriented
• 38:15to what the collective is doing.
• 38:17We've also provided support,
• 38:19along with our colleague Andy
• 38:21Harper and Bridget,
• 38:22in helping the group to develop
• 38:24advocacy strategies as partners,
• 38:26securing grant funding,
• 38:28organizing photo voice exhibits,
• 38:30connecting with food security coalitions
• 38:32that are operating around the city.
• 38:34Witnesses pictured here on the upper
• 38:36left at a press conference at City
• 38:39Hall announcing food summer meals,
• 38:41program for kids.
• 38:42And in the picture,
• 38:43I want to acknowledge Witnesses leader
• 38:44Wanda Perez, who recently passed away.
• 38:47We went Rest in Power Wanda and then
• 38:50the last group pictured here is
• 38:52during Michael's final year at Perch.
• 38:55We were asked,
• 38:55we were approached and asked to
• 38:57organize with a group of Unhoused
• 38:59leaders and and Housed allies to form
• 39:01the Unhoused Activist Community Team,
• 39:03otherwise known as U Act.
• 39:06The group is pictured here rallying
• 39:07in support of Keith Petrulis
• 39:09who was one of our leaders,
• 39:10unhoused leaders who was kicked out
• 39:13of his place where he was living
• 39:16in an entryway down in 9th square.
• 39:18He later passed at at another
• 39:21outdoor location downtown.
• 39:23So I want to acknowledge him
• 39:24and and rest in power.
• 39:25Keith, he was a good friend of ours.
• 39:28We provide support.
• 39:29The Perch team provide support to you ACT
• 39:31leaders in cofacilitating the weekly groups,
• 39:34doing outreach,
• 39:35other activities of the group
• 39:37and community organizing support.
• 39:40And they're we we support them in
• 39:42their demands that the policymakers
• 39:44acknowledge and eliminate the
• 39:46trauma that's caused by the de facto
• 39:48criminalization of homelessness
• 39:49here in New Haven.
• 39:50We've also taught residents and
• 39:53fellows through the citizenship lens,
• 39:55mostly through the social justice
• 39:57and HealthEquity curriculum here
• 39:58in the department.
• 39:59And Bridge is going to talk a
• 40:00little bit more about that.
• 40:03Thank you again, Bill. So the residents,
• 40:06I love to take the residence.
• 40:08I think I've been doing that for like 5 or
• 40:10six years and the reason why I really could.
• 40:13Commit to doing that is because for one,
• 40:16I don't want the residents to
• 40:18be making movies about what
• 40:19they think about Dixwell Ave.
• 40:21because you hear so much,
• 40:22you know negative stuff about Dixwell.
• 40:24So I like to keep it 100 with
• 40:26them and tell them the truth in
• 40:28the history of about Dixwell Ave.
• 40:31Not only that,
• 40:32but before I take them out,
• 40:34I go through Dixwell Avenue.
• 40:35I go to the leaders there,
• 40:38the block watchers,
• 40:39the drug dealers and let them know
• 40:41that I'm coming through there with
• 40:43the residents so that we can be
• 40:45able to get through there safely.
• 40:47And not that I'm bringing, you know,
• 40:49police or or people to set them up.
• 40:52So I think that's important to let the
• 40:54community know that I'm coming through
• 40:56and then when I come through there,
• 40:58it's really weird because you know,
• 41:00academia folks are so used
• 41:03to controlling their space.
• 41:04It's like the road switch.
• 41:06Now they in my court and you know,
• 41:09I'm a basketball player used to be.
• 41:11So when I say court, they in my space.
• 41:14So now the road switch,
• 41:15you're listening to me and to see
• 41:19that happening and see all the
• 41:21questions that's being asked about
• 41:24the community that we walking through.
• 41:26But I really tell them more than
• 41:29the truth because I got over 60
• 41:31years of experience on Dixville.
• 41:33So I need them to know all
• 41:35the stuff that's happening.
• 41:37So when they are meeting
• 41:39folks inside their community,
• 41:41that meeting folks inside their office,
• 41:43they have a little idea of, you know,
• 41:46where the person is coming from.
• 41:47But not just that.
• 41:48I don't need them to come through
• 41:50just to do that drive by when
• 41:52I bring them through that,
• 41:53I need them continue on coming through
• 41:56there because relationships are the
• 41:58key to helping people move forward.
• 42:01And another thing I just want to say,
• 42:03I appreciate you, Michael,
• 42:04for putting me on your team
• 42:07because without you,
• 42:08I don't know where I'll be at.
• 42:10And Doctor Belly,
• 42:11and I also want to thank you for seeing
• 42:13stuff in me that I didn't see in myself.
• 42:15Thank you,
• 42:17Michael Rowe.
• 42:18And
• 42:18I also want to say thanks to Michael
• 42:20for teaching us how to actually do
• 42:21citizenship and taking out of the
• 42:23conceptual and making an actual thing
• 42:25that makes differences in so many lives.
• 42:27And I also want to thank you for encouraging
• 42:29us to find the edge of of citizenship,
• 42:31Michael, and to continue to push
• 42:33through that edge and make innovations.
• 42:35So thank you. And we're going to hand
• 42:37it over to our colleague, Allison.
• 42:48I'm sorry, my computer just throws up.
• 42:50Can you see me now and hear me,
• 42:51Okay? Great. Thanks.
• 42:53Thank you, Bridget.
• 42:54And Billy, I'm Allison Ponce.
• 42:56I'm a clinical psychologist and
• 42:57professor in the Department
• 42:58of Psychiatry here at Yale,
• 43:00and I'm based at Connecticut
• 43:01Mental Health Center.
• 43:03So I'd like to talk
• 43:04a little bit about how citizenship
• 43:06has actually affected us as scholars
• 43:08and mentees and colleagues.
• 43:10And wondering with you about how our
• 43:12engagement with this work has broadened
• 43:14our views of our own citizenship and
• 43:16our own enactment of the five R's.
• 43:18We've heard lots of descriptions
• 43:19today about how the model has
• 43:21been implemented with different
• 43:23populations in different countries
• 43:24with widely varied applications,
• 43:25and I can add to this list.
• 43:27I've been lucky to be involved
• 43:29in this work over the years,
• 43:30thinking about how it applies
• 43:31to different populations,
• 43:32people who have just as involvement,
• 43:34people with serious mental illness,
• 43:36people without homes.
• 43:39Sorry about the siren here,
• 43:41but what strikes me is all of the ways
• 43:43that the model itself is actually created.
• 43:45Community.
• 43:46Just look at this panel today. People
• 43:47from all over the world,
• 43:50so sorry about that,
• 43:52who have been drawn to this concept,
• 43:54the universality of the idea
• 43:56that these fundamental elements
• 43:58are crucial to having a full and
• 44:00meaningful life in the community.
• 44:02So I'd like to suggest that we reflect
• 44:04for a couple of moments about why
• 44:05this resonates for
• 44:06us. What does it feed in us?
• 44:09How does awareness of the citizenship model,
• 44:11whether you helped create it or you're
• 44:13hearing about it today for the first time,
• 44:15how does it change not just the way
• 44:16we think about other people's access
• 44:18to citizenship and how it applies
• 44:20to each of us?
• 44:22I think the answer is
• 44:24completely person dependent.
• 44:25How I experience responsibility
• 44:26or roles or relationships is
• 44:29different than how you do.
• 44:30But the fact that these ours
• 44:32undergird our shared human experience
• 44:34is really on display today,
• 44:36as we hear from colleagues and
• 44:38Quebec and Hong Kong and Spain and
• 44:40Scotland and here in New Haven.
• 44:42So I'd like to invite you
• 44:43to think about this.
• 44:44How can an interrogation of our
• 44:47own connections to the five R's,
• 44:49the elements that connect us to one
• 44:51another and to our experience of the world,
• 44:53how can that help us discover new ways
• 44:55to use the citizenship model to move
• 44:58it even further out into the world,
• 45:00to impact even more people and
• 45:03more structures and more systems?
• 45:05So I recognize we're getting
• 45:06a little short on time now.
• 45:07So I'll,
• 45:07I'll end my remarks because I think
• 45:09we all want to hear from Michael.
• 45:11And without Michael,
• 45:12none of this work would be possible.
• 45:14And I'm very grateful for all of
• 45:16the sort of care you've taken
• 45:18of me as a colleague.
• 45:19Michael and I pass it on to you.
• 45:27Thank you. Allison.
• 45:30My screen just changed. Can you see me?
• 45:36And Good morning all and 1st I'm going
• 45:38to thank all of the presenters for your
• 45:41citizenship work and your kind words.
• 45:43The reason there's any praise to give
• 45:45me is the reason I have to praise
• 45:46you and others who do this work,
• 45:48which otherwise would have sunk like a stone
• 45:51in the early 2000s but instead is floating.
• 45:55It's even sailing.
• 45:57So thank you many others to thank,
• 46:01but lack of time today.
• 46:03Other other names will be added to
• 46:05the PowerPoint on the department's
• 46:07website for this brand rounds.
• 46:09But I must acknowledge doctor Cheryl
• 46:12Bellamy for the idea of having this forum
• 46:15and Grazio Reese for coordinating it.
• 46:17Also want to acknowledge Patty Benedict,
• 46:19the heart of our citizenship
• 46:20work for many years.
• 46:22And remember Leslie Two Bears fondly.
• 46:25I also want to acknowledge DAMAS for
• 46:28their long time support for this work.
• 46:31So I just have just a few minutes
• 46:33to make five points about innovation
• 46:36in community mental health with
• 46:38citizenship as the case example.
• 46:40So my first point is have a
• 46:42promising idea or a hypothesis that's
• 46:44based on some evidence,
• 46:46although the evidence may be that
• 46:48of observation in depth interviews
• 46:51or consideration of a concept.
• 46:53So if the current idea for
• 46:56creating an integrated system of
• 46:58care is called No Wrong Door,
• 46:59you get in one door and
• 47:00you get into all of them.
• 47:02You may be walking down the
• 47:03street one morning and think,
• 47:04Oh my God,
• 47:05we forgot to think about who would
• 47:07be at the door to let people in.
• 47:11Second point,
• 47:11heaven and help to create a hub
• 47:13that brings creative people
• 47:15together and keeps the work going.
• 47:17Perch has been that hub at Yale,
• 47:19C&HC for Annie, Billy, Bridget,
• 47:23and many others.
• 47:24I think the School of Social Work and
• 47:27Social Policy at the University of
• 47:30Strathclyde has been a hub for Jillian
• 47:33and the Richmond Fellowship for Fiona.
• 47:36Third Point reach out to
• 47:39and involve connectors.
• 47:40Eric,
• 47:41ahead of the inpatient Psychology
• 47:43service for CMHC,
• 47:45is a new citizenship connector.
• 47:48Ellis and Director of Education
• 47:50at CMHE is a long time partner in
• 47:52this work and a link for ongoing
• 47:54citizenship educational work
• 47:56and training at CMHC and Dean is
• 47:58through the Recovering Citizenship
• 48:00Learning Collaborative.
• 48:03Doctor Pelletier is a is a connector,
• 48:05cofounder of the International
• 48:07Recovery and Citizenship Collective
• 48:09starting around 2012 with perch,
• 48:12demis and a bumpy ride to the
• 48:16University Of Montreal on a prop
• 48:18plane that the pilot had to move
• 48:20us around on to get the weight
• 48:22balanced on both sides of the aisle
• 48:25That is now an 11 nation collective
• 48:27across four or five continents.
• 48:31Francesco is a connector, too,
• 48:33for academics, peers, clinicians in Spain,
• 48:37Caledonia for citizenship work.
• 48:41Fourth point Innovation in mental
• 48:44health doesn't involve only coming up
• 48:46with fixes for identified problems,
• 48:49but uncovering problems or gaps that
• 48:52haven't been fully conceptualized before.
• 48:55Financial health in in
• 48:57community mental health.
• 48:58Where did you hear of that until
• 49:01you heard of Annie Harper?
• 49:05Community training for residents
• 49:07in psychiatry by peers,
• 49:09community organizers and community guides.
• 49:12Where did you hear about that before
• 49:14Doctor Rohrbaugh, Billy Brumage,
• 49:16Bridget Williamson and others?
• 49:18Citizenship as Health Francesco Aeroa Rosa.
• 49:25Fifth Point Values stand
• 49:29behind techniques and training.
• 49:32Allison talking about the
• 49:34aspirational nature of citizenship,
• 49:36which seemed obvious to her,
• 49:38but naming it made a difference.
• 49:41Fiona embracing and extending the idea of
• 49:44recovering citizenship from a 2016 paper,
• 49:47From Perch to a new direction for the work
• 49:50of the Richmond Fellowship in Hong Kong.
• 49:53Jillian and colleagues practicing a
• 49:55community and people wide approach to
• 49:58mental health from their base in Glasgow.
• 50:02Billy Brummage bringing the values
• 50:04of community organizing to the
• 50:06practice of collective citizenship.
• 50:09Bridget Williamson and and Jean
• 50:11Francois bringing different
• 50:13approaches and inspiration to pure
• 50:16work training and empowerment.
• 50:18And finally I would say look to
• 50:20your professions for values to
• 50:22guide and support your work.
• 50:24Psychiatry, peer work,
• 50:27psychology, social work, nursing,
• 50:31case work, case management.
• 50:34Do they support the values behind
• 50:36citizenship, recovery, anti racism,
• 50:38social equity and inclusion?
• 50:43Billy and I did a little bit of work
• 50:45looking at some of the professions
• 50:48and and felt that if you looked,
• 50:50if you really looked at them,
• 50:51they were supporting most of these values.
• 50:55So if they are supporting them, that's great.
• 50:58If they're not, they should.
• 51:00And if they do support them,
• 51:02they not only back you up,
• 51:03but they require you to bring
• 51:05those values to your workplace.
• 51:08And I think I'm pretty much out of
• 51:09time and we wanted to leave a little
• 51:11bit of a bit of time for questions.
• 51:13So I will turn it back to Doctor
• 51:16Harper Annie Harper for Q&A.