
{"id":22444,"date":"2011-12-15T12:35:42","date_gmt":"2011-12-15T17:35:42","guid":{"rendered":"http:\/\/www.carrborocitizen.com\/main\/?p=22444"},"modified":"2011-12-22T18:24:23","modified_gmt":"2011-12-22T23:24:23","slug":"a-person-centered-approach-to-recovery","status":"publish","type":"post","link":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/2011\/12\/15\/a-person-centered-approach-to-recovery\/","title":{"rendered":"A &#8216;person-centered&#8217; approach to recovery"},"content":{"rendered":"<p><figure id=\"attachment_22445\" aria-describedby=\"caption-attachment-22445\" style=\"width: 350px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/www.carrborocitizen.com\/main\/wp-content\/uploads\/2011\/12\/Oasis121511.jpg\" alt=\"\" title=\"\" width=\"350\" height=\"431\" class=\"size-full wp-image-22445\" srcset=\"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-content\/uploads\/2011\/12\/Oasis121511.jpg 350w, https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-content\/uploads\/2011\/12\/Oasis121511-113x139.jpg 113w, https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-content\/uploads\/2011\/12\/Oasis121511-91x113.jpg 91w, https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-content\/uploads\/2011\/12\/Oasis121511-81x100.jpg 81w\" sizes=\"auto, (max-width: 350px) 100vw, 350px\" \/><figcaption id=\"caption-attachment-22445\" class=\"wp-caption-text\">David Binanny is founder of Music Over Mind and a professional musician.\u00c2  Photo by Alicia Stemper<\/figcaption><\/figure><strong>By Taylor Sisk<\/strong><br \/>\n<em>Staff Writer<\/em><br \/>\n<em>This is the final installment in a three-part series on the onset of psychosis in young adults, its treatment and UNC\u00e2\u20ac\u2122s Outreach and Support Intervention Services program.<\/em><br \/>\n<a href=\"http:\/\/www.carrborocitizen.com\/main\/oasis-\u00e2\u20ac\u201c-charting-a-path-to-recovery\/\">[OASIS series main page]<\/a><\/p>\n<p>The UNC Outreach and Support Intervention Services program is the only one of its kind in the Southeast and among only a few such programs in the country.<\/p>\n<p>Launched in 2005 with funding from the Duke Endowment and the Kate B. Reynolds Charitable Trust, OASIS has scrambled for funding since those grants expired in 2008. About a quarter of its clients are uninsured; those with private insurance and Medicaid are covered for only certain services.<\/p>\n<p>The program\u00e2\u20ac\u2122s objectives are to engage young people in treatment of the onset of psychosis and assist them in regaining social and occupational functioning, aiming to prevent disability from a psychotic disorder. It\u00e2\u20ac\u2122s a matter of redirecting the course of the illness through early intervention.<\/p>\n<p>Each client in the program has a \u00e2\u20ac\u0153key worker\u00e2\u20ac\u009d who\u00e2\u20ac\u2122s responsible for engaging the client and family. That person serves as a case manager, primary clinician and therapist. Treatment planning is person-centered, focusing on the client\u00e2\u20ac\u2122s goals. <\/p>\n<p>OASIS sees young people who have had a first episode of psychosis or a new onset psychosis or who\u00e2\u20ac\u2122ve had psychotic symptoms for less than three years. Typically, an illness like schizophrenia first occurs in late adolescence and early adulthood, though occasionally it strikes earlier.<\/p>\n<p>Clients as young as 16 and as old as 36 have been treated at OASIS, but most are between 19 and 24, typically a tumultuous time in most anyone\u00e2\u20ac\u2122s life. You\u00e2\u20ac\u2122re trying to figure out who you are, where you\u00e2\u20ac\u2122re headed \u00e2\u20ac\u201c and now this.<\/p>\n<p>Family members might notice a change in behavior. \u00e2\u20ac\u0153It can go from isolating themselves to having a flat affect,\u00e2\u20ac\u009d says OASIS program director Sylvia Saade, \u00e2\u20ac\u0153like the emotions are not there or they feel they\u00e2\u20ac\u2122re in a different space altogether. They\u00e2\u20ac\u2122re into their own world.\u00e2\u20ac\u009d<\/p>\n<p>Or it could be something more severe: talking or smiling to oneself or a dramatic drop in academic performance.<\/p>\n<p>At that early stage, the verdict\u00e2\u20ac\u2122s still out on the course of the psychosis, and quite a few young people reach significant or full recovery, says Bebe Smith, an OASIS founder and co-director of UNC\u00e2\u20ac\u2122s Center for Excellence in Community Mental Health, which administers OASIS. <\/p>\n<p>\u00e2\u20ac\u0153The exciting thing about early-psychosis work is that we\u00e2\u20ac\u2122ve seen that with appropriate treatment, some people make very good recoveries from that initial stage,\u00e2\u20ac\u009d Smith says.<\/p>\n<p>\u00e2\u20ac\u0153Some go ahead and become doctors or lawyers,\u00e2\u20ac\u009d Saade says, \u00e2\u20ac\u0153others adjust.\u00e2\u20ac\u009d<\/p>\n<p><strong>\u00e2\u20ac\u02dcOn when you\u00e2\u20ac\u2122re scared\u00e2\u20ac\u2122<\/strong><br \/>\nDavid Binanay was diagnosed with schizophrenia in 2006, when he was a year out of college.<br \/>\nIn the early days of his illness, Binanay came to OASIS at least once a week. <\/p>\n<p>\u00e2\u20ac\u0153It was therapy, exercise, body health, medicine compliance, staying active, getting in groups and talking about your experience,\u00e2\u20ac\u009d he says.<\/p>\n<p>\u00e2\u20ac\u0153You have to get out there and have those new experiences. You have to go on when you\u00e2\u20ac\u2122re scared.\u00e2\u20ac\u009d<figure id=\"attachment_22446\" aria-describedby=\"caption-attachment-22446\" style=\"width: 350px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/www.carrborocitizen.com\/main\/wp-content\/uploads\/2011\/12\/OasisForJump121511.jpg\" alt=\"\" title=\"\" width=\"350\" height=\"530\" class=\"size-full wp-image-22446\" srcset=\"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-content\/uploads\/2011\/12\/OasisForJump121511.jpg 350w, https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-content\/uploads\/2011\/12\/OasisForJump121511-99x150.jpg 99w, https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-content\/uploads\/2011\/12\/OasisForJump121511-74x113.jpg 74w, https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-content\/uploads\/2011\/12\/OasisForJump121511-66x100.jpg 66w, https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-content\/uploads\/2011\/12\/OasisForJump121511-303x460.jpg 303w\" sizes=\"auto, (max-width: 350px) 100vw, 350px\" \/><figcaption id=\"caption-attachment-22446\" class=\"wp-caption-text\">Sylvia Saade is program director of the UNC Outreach and Support Intervention Services program. Photo by Alicia Stemper<\/figcaption><\/figure><\/p>\n<p>Success in the OASIS program is measured by both symptom and functional recovery. Some see their symptoms go away completely; others will learn to manage those that remain. The success rate in terms of functional recovery, meaning returning to school or work, is 60 to 65 percent.<\/p>\n<p>Service utilization is another measure of success at OASIS, defined by how many clients receive disability benefits, are hospitalized or have legal issues. <\/p>\n<p>\u00e2\u20ac\u0153How much we can save in taxpayer dollars is extremely important to knowing if our intervention is working,\u00e2\u20ac\u009d Saade says.<\/p>\n<p>OASIS is designed to serve 100 clients; the program is presently seeing about 130. It\u00e2\u20ac\u2122s difficult to turn away those in need when their other options are limited or nonexistent.<\/p>\n<p>\u00e2\u20ac\u0153Other countries do a much better job in terms of early psychosis than we do,\u00e2\u20ac\u009d Smith says, citing the UK, Australia and Canada in particular. These countries, she says, have countrywide initiatives targeting psychosis and getting kids into treatment very quickly if needed.<\/p>\n<p>\u00e2\u20ac\u0153Those countries do better because they have more cohesive health care systems and better social-welfare systems,\u00e2\u20ac\u009d Smith says.<\/p>\n<p><strong>Rebuilding<\/strong><br \/>\nLife was good when Binanay was blindsided by his illness. He\u00e2\u20ac\u2122s musically gifted and was a campus leader at Cardinal Gibbons High School in Raleigh and then at Villanova University. Schizophrenia arrived unawares, as it will, and overwhelmed the Binanay family.<\/p>\n<p>\u00e2\u20ac\u0153They had to go through a recovery process as well,\u00e2\u20ac\u009d Binanay says of his family. \u00e2\u20ac\u0153I think they\u00e2\u20ac\u2122re still recovering.\u00e2\u20ac\u009d<\/p>\n<p>Family support very often plays a deciding role in recovery. Appropriate medication management to avoid or minimize side effects is another important element, says OASIS medical director Diana Perkins.<\/p>\n<p>\u00e2\u20ac\u0153You need a really good psychiatrist who knows these medications,\u00e2\u20ac\u009d she says.<\/p>\n<p>Most importantly, recovery requires finding the right treatment for the individual, and, Saade says, staying mindful that the illness need not be a debilitating one.<\/p>\n<p>\u00e2\u20ac\u0153We must take away that image,\u00e2\u20ac\u009d she says, referring to popular perceptions of mental illness, \u00e2\u20ac\u0153whether it is schizophrenia or bipolar or major depression, that I\u00e2\u20ac\u2122m going to end up being homeless or on disability. No. We have people moving on with their Ph.D.s, getting married \u00e2\u20ac\u00a6\u00e2\u20ac\u009d<\/p>\n<p>Binanay is engaged to be married next year. He\u00e2\u20ac\u2122s also founded a nonprofit called Music Over Mind, which brings music to hospitals and clinics while raising awareness about mental illness. He\u00e2\u20ac\u2122s in a band called Black Heart Kings.<\/p>\n<p>Binanay\u00e2\u20ac\u2122s recovery took a long time, Perkins says. \u00e2\u20ac\u0153He had multiple episodes until he figured it out.\u00e2\u20ac\u009d <\/p>\n<p>\u00e2\u20ac\u0153When I got sick, I couldn\u00e2\u20ac\u2122t speak, I couldn\u00e2\u20ac\u2122t remember,\u00e2\u20ac\u009d Binanay says. \u00e2\u20ac\u0153Now it\u00e2\u20ac\u2122s like, \u00e2\u20ac\u02dcOh, I live here, I have this girlfriend, I play the violin.\u00e2\u20ac\u2122 I can recall these things. Before it was just blank.\u00e2\u20ac\u009d<\/p>\n<p>\u00e2\u20ac\u0153You have to rebuild the pathways of experience,\u00e2\u20ac\u009d he says, \u00e2\u20ac\u0153and that\u00e2\u20ac\u2122s what I\u00e2\u20ac\u2122ve done. I\u00e2\u20ac\u2122ve stayed engaged, stayed active, and I\u00e2\u20ac\u2122ve rebuilt those pathways.\u00e2\u20ac\u009d <\/p>\n<p>Binanay says that OASIS helped him understand from a medical perspective what was happening while remaining open to what he interpreted as a spiritual experience. <\/p>\n<p>His support team accepts his belief that, \u00e2\u20ac\u0153The mind wants to do all these things; it wants to build and put all these things together, and solve. [But] the heart\u00e2\u20ac\u2122s already done it. The heart\u00e2\u20ac\u2122s already won.\u00e2\u20ac\u009d<\/p>\n<p>That perspective, with OASIS\u00e2\u20ac\u2122 support, has helped provide a pathway to recovery.<\/p>\n<p>\u00e2\u20ac\u0153They help you walk back to reality,\u00e2\u20ac\u009d Binanay says. \u00e2\u20ac\u0153They\u00e2\u20ac\u2122ve really been the guide for me to come back.\u00e2\u20ac\u009d<\/p>\n<p>\u00e2\u20ac\u0153It\u00e2\u20ac\u2122s changed him,\u00e2\u20ac\u009d Perkins says, \u00e2\u20ac\u0153because it does in the same way that anything that\u00e2\u20ac\u2122s traumatic or difficult will change the way you look at the world. But it\u00e2\u20ac\u2122s good; he\u00e2\u20ac\u2122s integrating in a way that\u00e2\u20ac\u2122s good, and works for him, and he\u00e2\u20ac\u2122s now moving forward in life.\u00e2\u20ac\u009d<\/p>\n<p>Binanay believes that while he was once quicker witted, he\u00e2\u20ac\u2122s now more reflective.<\/p>\n<p>\u00e2\u20ac\u0153Whereas I once was like that,\u00e2\u20ac\u009d he says, drawing his fingertips to a point, \u00e2\u20ac\u0153now it\u00e2\u20ac\u2122s more like this,\u00e2\u20ac\u009d cupping his hands. That\u00e2\u20ac\u2122s somewhat due to the medication, he says. \u00e2\u20ac\u0153But that\u00e2\u20ac\u2122s a choice I made, to be on medicine.<\/p>\n<p>\u00e2\u20ac\u0153I think I could go to some temple and get off my medicine, and I think I\u00e2\u20ac\u2122d be OK, because now I know what to expect. But there\u00e2\u20ac\u2122s that risk that you may not be able to come back. It\u00e2\u20ac\u2122s been six, seven years to get to where I am today.\u00e2\u20ac\u009d <\/p>\n<p>Meanwhile, \u00e2\u20ac\u0153There are a few new medications on the horizon that look promising, that work a little bit differently,\u00e2\u20ac\u009d Perkins says. \u00e2\u20ac\u0153We\u00e2\u20ac\u2122ll have to see how those turn out.\u00e2\u20ac\u009d<\/p>\n<p>\u00e2\u20ac\u0153We\u00e2\u20ac\u2122re also just now beginning to get a handle on the genetic basis of the illness,\u00e2\u20ac\u009d she says, \u00e2\u20ac\u0153and what the different kinds of schizophrenia can be. <\/p>\n<p>\u00e2\u20ac\u0153We\u00e2\u20ac\u2122re really at a point where technology, science is allowing us to explore these things in a way that we just couldn\u00e2\u20ac\u2122t five years ago. So it\u00e2\u20ac\u2122s a really exciting time to be doing this research.\u00e2\u20ac\u009d<\/p>\n<p>Will there be a cure in our lifetime? <\/p>\n<p>\u00e2\u20ac\u0153I think it\u00e2\u20ac\u2122s certainly possible,\u00e2\u20ac\u009d Perkins says, citing research she and others are doing with stem cells.<\/p>\n<p>\u00e2\u20ac\u0153Maybe if you catch it really early, you prevent it from happening in the first place.\u00e2\u20ac\u009d <\/p>\n<p><strong>The harvest<\/strong><br \/>\n\u00e2\u20ac\u0153Every day, every night, nonstop; you have to work at it,\u00e2\u20ac\u009d Binanay emphasizes. \u00e2\u20ac\u0153You have to move it around. You can\u00e2\u20ac\u2122t just sit and let it heal itself.\u00e2\u20ac\u009d <\/p>\n<p>He welcomes the opportunities he has to talk with new clients. \u00e2\u20ac\u0153I know what it\u00e2\u20ac\u2122s like in the beginning, to be scared, to not know what\u00e2\u20ac\u2122s going on; the change is happening, but then it\u00e2\u20ac\u2122s, like, you do heal.\u00e2\u20ac\u009d<\/p>\n<p>\u00e2\u20ac\u0153I want to try to give back as much as possible, till the end, keep on pouring it out,\u00e2\u20ac\u009d he says. \u00e2\u20ac\u0153Because I have so much to give. I just want to keep pouring it out.\u00e2\u20ac\u009d<\/p>\n<p>\u00e2\u20ac\u0153It\u00e2\u20ac\u2122s a process,\u00e2\u20ac\u009d Binanay says. \u00e2\u20ac\u0153I\u00e2\u20ac\u2122ve got these apples in my orchard that are ready to harvest, because I did the work every day.\u00e2\u20ac\u009d <\/p>\n","protected":false},"excerpt":{"rendered":"<p>The UNC Outreach and Support Intervention Services program is the only one of its kind in the Southeast and among only a few such programs in the country.<\/p>\n","protected":false},"author":9,"featured_media":22445,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4],"tags":[],"class_list":["post-22444","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-news"],"_links":{"self":[{"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/posts\/22444","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/users\/9"}],"replies":[{"embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/comments?post=22444"}],"version-history":[{"count":5,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/posts\/22444\/revisions"}],"predecessor-version":[{"id":22583,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/posts\/22444\/revisions\/22583"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/media\/22445"}],"wp:attachment":[{"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/media?parent=22444"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/categories?post=22444"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/tags?post=22444"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}