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Out of madness comes hope and recovery
September 2004
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Escaping madness is a tunnel
Thoughts, visions, voices in a funnel
Screams unheard by anyone else
Dark people among the living self — Yvonne
Rice
"I've tried to kill myself many times to escape
the horrible voices and visions…"
With a soft voice and slight build, 42-year old
Yvonne Rice begins a powerful story of survival. It is a journey
to hell and back.
"I've been in out of hospitals all my life including
the Oregon State Hospital in 2001. I've been on more than 20
different kinds of medications. And I' ve had electric shock
therapy twice — 12 treatments each time. I remember the
years I was tied down — handcuffed to the ground by police
and security guards — and medicated into insensibility."
At 19
years of age Yvonne was diagnosed with schizoaffective disorder — a
mental illness she's been battling for more than 20 years. She's
suffered severe hallucinations and depression, and paranoia followed
her every move.
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A story of survival...a journey to recovery
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But between her episodes of illness — and hospitalizations — Yvonne
appeared to function normally. She held several good jobs, completed
her master's degree and became a licensed clinical social worker.
But her world of success masked a life that was slowly unraveling.
Darkness is your destiny…
"I had gone to work in private practice — so I was working
alone and I was under a lot of pressure to succeed,"she remembers. "Then
a close personal friend passed away. But I think the biggest stressor
of all was I had to continually hide the fact that I had a mental illness — because
of the stigma. If I was having a bad day I'd tell people I had
the flu."
Yvonne says the guilt and shame of lying became a burden she could no
longer bear. She was taking medication for her illness but remembers
nothing seemed to help.
"I began having an increase in symptoms. I began
hearing voices again, seeing people dressed in black following me,
seeing dead things
falling from the ceiling. I thought all food was poison. I was literally
hanging on by my fingertips. One day, earlier this year, I just snapped
and took an entire bottle of Tylenol PM to get rid of the screaming in
my head."
Voices
You are not of this world but of one darker and deeper…
Darkness is your destiny.
We will follow you until you are dead. — Yvonne Rice
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A new beginning
That day Yvonne ended up in Salem Hospital where
she was treated and eventually released. But when it was time
to leave her doctor told her about an organization called the
Telecare Recovery Center.
"At that point I was hopeless and my only alternative
was the state hospital. So I decided to give the Recovery Center
a try. When I first got there I thought — gosh — this
is really a strange place."
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The Telecare Recovery Center (TRC) in Gresham, Ore.
is a secure 16-bed in-patient facility for persons who can benefit
significantly from treatment
but whose needs fall somewhere in between what's offered in an
acute care setting and longer-term institutionalization.
Partnership to recovery
TRC opened its doors in April 2002 as a public-private
partnership between DHS's Office of Mental Health & Addiction Services (OMHAS)
and Telecare Corporation, a privately owned California-based provider
with more than 40 years' experience in developing programs for people
with serious mental illness — programs that are saving Oregon millions
of dollars every year.
"In 2001, DHS was facing a financial crisis," remembers
OMHAS Administrator Bob Nikkel," and at the time there were very
few options for people who needed a secure level of treatment. There
was a long waiting list for beds at the state hospital and so these people
often remained in acute care hospitals."
According to Nikkel, this population of people was consuming
up to 15 percent of the state's acute care bed capacity and costing
the state about $800 per person per day.
"We were using considerable resources but these
people were not being treated in the most appropriate setting nor were
they gaining the
skills needed to take personal control of their illness and create a
meaningful life. So the state began exploring other community-based alternatives
and more cost-effective ways to help these people."
Cooperation — not
control
To meet the challenge DHS began collaborating
with Telecare to develop an innovative post-acute treatment program
in Oregon that incorporated a recovery-based approach. And that
was unique.
"There are other companies that are moving in
the recovery direction,"says Nikkel, "but TRC was the first program
in Oregon that took recovery into its name and started as a recovery
center from the ground up. With TRC recovery isn't just a theory,
it's infused into all programs and processes from day one."
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Kevin McChesney, Telecare Recovery
Center and Bob Nikkel, OMHAS Administrator
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"Our programs are built upon the premise that every person with
a mental illness can recover and reach their full potential,"explains
Kevin McChesney, TRC's executive administrator in Gresham. "One
of the problems with traditional models for treating serious mental illness
is that the programs are based on control and power. ‘I know what's
wrong with you and here's what you should work on.' It's
a very negative model. At Telecare we provide a caring environment and
provide people with hope and we do it with a feeling of cooperation — not
control."
Choices
In fact Yvonne found Telecare completely different from
anything she'd
ever experienced.
"I had a psychotic incident not long after I was admitted,"she
says quietly. "I was waiting to get attacked and put in seclusion,
but instead of a bunch of people grabbing me and restraining me, I was
approached by one staff person who talked to me using a very calm, direct
manner — and the person offered me choices. There were limitations,
of course. The person said, ‘we don't want you to hurt yourself,' but
I was offered alternatives as to how I wanted to discontinue my self-harming
behavior. That freedom started giving me a sense of accountability and
responsibility over my own recovery."
According to McChesney residents start creating their
own recovery plans as soon as they're admitted. Instead of focusing mainly on symptom
management and behavior control, programs focus on empowering residents
to make effective, personal choices about everything in their lives — from
treatment to schedules to personal crisis plans — all in a community-like
environment.
"We try to not make anything mandatory,"says McChesney. "For
example, we have group therapy but we try to let clients choose whether
or not to go and what groups they feel would be most effective for
them. And because we have a high staff-to-resident ratio we actually
spend less time on group therapy and more time doing one-on-one counseling
that provides residents with highly personalized support."
"You feel so included in the process,"says Yvonne, "including
making choices about your medications. You're not lumped into a
group: ‘you're a schizophrenic — take this medication.' You
learn about the drugs and how they affect your personal recovery."
Taking
control of her illness
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"I wanted more than survival…"
Yvonne remembers taking medications that eliminated
her delusions but zapped her energy. "I wanted more than survival,"she
explains. "I wanted a life."Yvonne worked with her doctor at
Telecare to find the right combination of drugs for her.
"My energy started coming back,"smiles Yvonne. "I started playing tennis again — getting
up and getting dressed — the things I'm supposed to do every day."
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"Art was my voice…"
Yvonne's situation continued to change dramatically
as she took control of her illness. If she felt she was struggling
and needed one-to-one time: "I could approach any staff person
and that person would talk to me."She wrote daily in her journal
and with the help and encouragement of an art therapist, she
began drawing and painting.
"Art was my voice when I couldn't speak,"she
says. "It was a safe way for me to talk."
Yvonne's early work mirrors
her delusionary past. Dark drawings jump from her sketchbooks. She
says in one painting there used to be a black hooded figure.
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"Darkness was my destiny..." one of Yvonne's early drawings.
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Tearing out the demons.
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"When I started feeling better,
I crossed him out,"she says. "Then I tore him completely out
of the picture — and out of my life. I wanted to get rid
of it and when I did the feeling of unburdening was tremendous."
Overcoming the stigma
Part of the recovery process also means overcoming
the stigma of mental illness and understanding — just like
diabetes or heart disease — it's a serious illness that
requires treatment.
"With the right type of treatment and right level
of care these individuals learn to take charge of their lives and
return to the community sooner with new hope and skills,"says McChesney. "Not
only is the quality of resident's lives enhanced, but the state
saves millions in health care costs."
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Saving the state millions
According to a 2004 Telecare report on the first two years of operation:
- TRC saved the state of Oregon approximately $4.9
million dollars in 17 months during treatment of its first 134 residents.
- For each admission, the state saved $37,000.
- Per day
a TRC resident costs the state $454 vs. $800 for acute care hospitalization.
- Average
length of stay at Telecare was 55 days; average length of stay
in state hospitals was 90 to 180 days.
- Telecare diverted more than 200 people from the Oregon State Hospital during a two-year period.
"I'm very proud of Telecare and our partnership with them,"says
Nikkel, "and we're working with them on other potential
projects. But it's also important to remember that TRC
is not a replacement
for the state hospital. That type of care is still needed.
But a lot of folks don't need that level of care and
Telecare fills a gap."
Going home
After three months at TRC, Yvonne
recently returned home to her husband and son.
"For the first time in my life
I feel I've been given a true shot at peace,"she
says. "My thinking is clear and concise. Most
of all I'm leaving Telecare with a sense of hope
and a belief that the medications and therapy
will ensure a lasting recovery."
Yvonne says she plans to return
to school and complete her Ph.D. in mental health
and counseling. She hopes to return to work at
a Telecare facility some day and help other people
with mental illness recover.
"I now have a chance to live my
life without the fear of falling into madness.
It's wonderful and a little scary, but I've never
felt so confident that I'll succeed."
Recovery is a flower
Within each of us is the power
Choice and respect will say
Decisions made each day — Yvonne Rice
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Recovery is a flower.
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Learn more
A Telecare Corporation news release about its work in
Oregon is on the
Internet.
 Back to top
— Nadine Jelsing, DHS Office
of Public Affairs, (503) 945-5950; email nadine.jelsing@state.or.us
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