Recovery Blog

Reflexology

What is Reflexology?

Reflexology is the application of appropriate pressure to specific points and areas on the feet, hands, or ears. Reflexologists believe that these areas and reflex points correspond to different body organs and systems, and that pressing them has a beneficial effect on the organs and person's general health. For example, reflexology holds that a specific spot in the arch of the foot corresponds to the bladder point. When a reflexology practitioner uses thumbs or fingers to apply appropriate pressure to this area, it affects bladder functioning.

massage of footAlthough reflexology is not used to diagnose or cure health disorders, millions of people around the world use it to complement other treatments when addressing conditions like anxiety, asthma, cancer treatment, cardiovascular issues, diabetes, headaches, kidney function, PMS, and sinusitis.

Reflexology is growing increasingly popular across Europe and Asia as both a complement to other treatments and as a preventive measure. One example is Denmark, where various municipalities and companies have employed reflexologists since the early '90s.

According to several studies, this practice in Denmark has resulted in reduced sick leave and absenteeism (and significant economic savings for the employers). Employees have consistently reported complete or partial improvement in conditions where they sought reflexologists' help and even relief for additional problems related to stress. In one municipal district, almost one-third of the employees reported greater satisfaction with their jobs after completing six sessions with a reflexologist.

Where are the reflexology points and areas?

In reflexology theory, points and areas on the feet, hands, and ears correspond to specific organs, bones and body systems. Practitioners access these points on the feet and hands (bottom, sides, and top) and the ear (both inside as far as the finger can reach and outside) to affect organs and systems throughout the entire body.

Maps of reflex points have been passed between practitioners across the globe. Understandably, there is not agreement among all reflexologists on all points; however, general agreement does exist on major reflex points. Some scientific documentation of linkages between the skin and internal organs also exists.

To represent how the body systems correspond to one another, reflexologists use reflexology "maps." A good example of a reflexology map exists for the feet. Each foot represents a vertical half of the body:

  • refloxology chartThe left foot corresponds to the left side of the body and all organs, valves, etc. found there.
  • The right foot corresponds to the right side of the body and all organs found there. For example, the liver is on the right side of the body, and therefore the corresponding reflex area is on the right foot.

The illustration to the right shows a reflexology map for the feet. For a map of the hands, see www.reflexology-research.com

A reflexologist may perform a general, integrated session, or may focus on specific problem areas on the feet, hands or ears. For example, if time is limited and the person really needs to relax, the reflexologist may choose just to work on the ears.

Whatever the approach, the reflexologist attempts to release congestion or stress in the nervous system and balance the body's energy.

How does reflexology relate to other therapies?

Acupuncture and Acupressure: Reflexology is similar to acupuncture and acupressure in that it works with the body's vital energy through the stimulation of points on the body. However, acupuncture/acupressure points do not always coincide with the reflex points used in reflexology.

foot massageReflexology and acupressure are both "reflex" therapies in that they work with points on one part of the body to affect other parts of the body. While reflexology uses reflexes that are in an orderly arrangement resembling a shape of the human body on the feet, hands, and outer ears, acupressure uses over 800 reflex points that are found along long thin energy lines called meridians that run the length of the entire body.

Massage: Some people confuse reflexology with massage. While both massage and reflexology use touch, the approaches are very different.

  • Massage is the systematic manipulation of the soft tissues of the body, using specific techniques (for example, tapping, kneading, stroking, and friction) to relax the muscles.
  • Reflexology focuses on reflex maps of points and areas of the body in the feet, hands, and ears using unique micromovement techniques such as thumb or finger walking and hook and backup to create a response throughout the body.

In short, massage therapists work "from the outside in," manipulating specific muscle groups or fascia to release tension. Reflexology practitioners see themselves as working "from the inside out" -- stimulating the nervous system to release tension.

Another difference between massage and reflexology is that a client will stay fully clothed for a reflexology session except for removing footwear, whereas clients remove clothing for a massage session.

Where does reflexology come from?

Because reflexology is an ancient practice, its origin and history is difficult to track. However, reflexology is thought to have been passed down through an oral tradition, and possibly first recorded as a pictograph on the Egyptian tomb of Ankhamor infeet imprints 2330 BC along with other medical procedures.

Reflexology symbols are also thought to be recorded on the feet of statues of Buddha in India and later China. The Chinese classic, the Yellow Emperor's Classic of Internal Medicine, which was written around 1,000 BC, has a chapter on "Examining Foot Method" and is the beginning of discussions in print about the connection of life force and points and areas on the feet.

It is believed that Marco Polo translated a Chinese massage book into Italian in the 1300s, thus introducing reflexology and massage to Europe. In 1582, a book on an integral element of reflexology called zone therapy was first published in Europe by Dr. Adamus and Dr. A'tatis.

In the United States, William H. Fitzgerald, MD, who is frequently referred to as the father of reflexology, wrote in 1917 about ten vertical zones that extended the length of the body. He found that the application of pressure to a zone that corresponded to the location of an injury could serve as relief of pain during minor surgeries.

Dr. Fitzgerald's work was expanded by Dr. Shelby Riley, who developed a map of horizontal zones going across the body and a detailed map of reflex points on the feet and hands. He also suggested pressure points on the outer ear.

Eunice Ingham, a physiotherapist who worked for Dr. Riley, is another prominent figure in the development of reflexology. In her research with zone therapy's pressure points, she found the feet to be the most sensitive and responsive. She developed the foot maps still in use today and introduced reflexology practices to the non-medical community in the 1930s. Ms. Ingham also designed one of the most commonly used reflexology charts, which has since been refined by her nephew, Dwight Byers, at the International Reflexology Institute.

In 1957, Dr. Paul Nogier recorded a reflex map of points on the outer ear. His work has been expanded by Oleson and Flocco and is now being taught as part of an integrated approach to hand, ear and foot reflexology.

References

Eriksen, L. (1992). Municipal Reflexology. Zoneterapeuten (Journal of the Danish Reflexologists Association, FDZ), 6.

Eriksen, L., & Levin, S. (1995). A Closeup View on Company Reflexology (Committee Report): Danish Reflexologists Association.

Enersen, O. D. (1994-2007). Head's Zones. Who Named It? Accessed May 24, 2007, from http://www.whonamedit.com/synd.cfm/636.html.

Frequently Asked Questions. (2007). Frequently Asked Questions Retrieved March 5, 2007, from http://www.americanacademyofreflexology.com/FAQsOf.shtml#DiffMass.

History of Reflexology. (2007). American Academy of Reflexology Retrieved March 4, 2007, from http://www.americanacademyofreflexology.com/HistoryOf.shtml.

Kristese, K., Moller, E., & Rasmussen, I. (1996). Reflexology as Personel Care in the Arthus District Corporation: Take Good Care of Your Fellow Employees. Zoneterapeuten (Journal of the Danish Reflexologists Association, FDZ), 1.

Madsen, S., & Andersen, J. (1993). Postal Reflexology (Committee Report): Odense Danish Reflexologists Association Research Committee Report.

Terp, H. (1995). Municipal Reflexology in Svendborg, A study of the Effect of Reflexology Treatment in the Eastern District of the Municiaplity of Svendborg, Denmark (Committee Report): Danish Reflexologists Association.


10 Ways to Boost Your Emotional Health

When you feel good about yourself, you're better able to manage small hassles as well as more serious problems that occasionally come along. These tips will help boost your self-esteem and keep your emotional health in great shape.

By Beth W. Orenstein

Medically reviewed by Lindsey Marcellin, MD, MPH

Taking care of your emotional health is as important as taking care of your physical body. If your emotional health is out of balance, you may experience high blood pressure, ulcers, chest pain, or a host of other physical symptoms.

When you feel good about yourself, it's much easier to cope with life's little ups and downs as well as bigger events, such as divorce or a death, says Jeff Gardere, PhD, a licensed clinical psychologist in New York City.

Here are 10 ways you can practice better stress management and boost your self-esteem. These strategies will help you stay resilient through everyday stresses and when larger personal issues arise.

1.    Grow your circle of friends. "It's very important that you have a support group of friends and family," Gardere says. "You need people whom you can talk to about your problems — people who will listen to you when you need to get things off your chest — so that you know you're not alone in whatever it is."

2.    Learn more. "Knowledge is power," Gardere says. If you have a problem, learn whatever you can about the issue or the health condition you're facing. The more you know, the less you will fear what might happen, Gardere says.

3.    Get moving. Any form of exercise that you enjoy will do. "Regular exercise works as a good partner for people who are on medication," Gardere says. Exercise also works well for people who have mild or moderate depression and don't need to be on medication. Think of it as a great tool for stress management.

4.    Have sex. Intimacy within a committed relationship has all sorts of emotional benefits — it can help make you feel good about yourself and boost self-esteem. "Figure out a schedule that works for you and your trusted partner — that could be once a week or three times a week or twice a month," Gardere says.

5.    Develop a passion. Everyone should have at least one hobby, Gardere says, whether it's taking care of plants, collecting antiques, or listening to music. You should do something that brings you some real joy — a passion that's all yours and that no one can take from you. Having a hobby and taking pride in it is a great way to boost self-esteem.

6.    Eat and drink in moderation. Alcohol can be a good stress reducer, but you must indulge in extreme moderation, Gardere says. The same advice applies to indulging in food. You can eat what you want and enjoy it as long as you eat smaller portions and get regular exercise, he says. Maintaining a healthy weight is important for your physical and your emotional health.

7.    Meditate or practice yoga. These types of activities are effective for stress management. Meditation is a focused form of guided thought. Yoga and tai chi, while movement-oriented, are also proven stress busters. Other stress-reducing techniques include deep breathing and progressive muscle relaxation. If you're unsure of how to get started, take a class and learn how to practice on your own for 30 minutes, three times a week.

8.    Manage your time. If you make a schedule and set goals for yourself for the week, "you'll be more on top of your days, and when you're more on top of your days, you're more on top of your life," Gardere says. As you cross off the tasks on your to-do list, you will feel a sense of accomplishment which will help reduce stress, he adds.

9.    Get enough sleep. "People who get a good night's sleep wake up with more energy and tend to be more productive," Gardere says. If you are overly tired, every task and responsibility can seem exaggerated, and even small problems will feel like big ones.

10.  Learn to say no. If you try to do more than you can handle, you will only end up frustrated and stressed out. If someone asks you to do something you absolutely can't do, say no. At the very least, ask for help. And if you can't do it, explain why kindly but firmly.

Nurturing your mind is as important as nurturing your body, and it will make you better able to handle whatever life throws at you. However, if your emotional problems are serious and you can't seem to shake them yourself, or if you're having issues with anxiety or depression, it's very important that you see a mental health professional and get help, Gardere says.


 Pleasures in Life That Help Relieve Stress

The search for happiness and an enjoyable life is pretty universal, and has spanned centuries. Thanks to the field of Positive Psychology, we now have a much more detailed understanding of what creates an enjoyable life. One way to relieve stress and make life more enjoyable is the pursuit of pleasures, which Positive Psychology researcher Christopher Peterson defines as “subjective positive psychological states that range from “raw feels” of the body produced by perfumes or back rubs to “higher” pleasures of the mind occasioned by Beethoven’s Ninth Symphony or the denouement of The Usual Suspects to the pleasures of accomplishment produced by the victory of a favorite political candidate or local football team”.

These pleasures, as mentioned, are subjective—one person’s deep tissue massage is another person’s painful manhandling, for example—but when the right pleasures are paired with the right individuals, they can bring a wonderful sense of delight, ranging from relaxation to glee to ecstasy. Their main drawback is that the positive feelings they bring are fleeting, and diminishing, a phenomenon known as ‘habituation’: upon successive experiences of the same pleasures, there is less return: the third bite of a cookie isn’t as delicious as the first

and a daily indulgence of cookies may bring less per-cookie pleasure than cookies eaten once a month, or once a year. (I believe this accounts for the wild success of Girl Scout Cookies in general, and Thin Mints in particular!) Also, greater doses of an originally pleasurable stimulus are often needed for the same thrill experienced initially, also thanks to habituation. Because of the rapid rate of habituation that comes with pleasures, it’s advisable to vary them often. To achieve a pleasurable life, it’s important to have some physical pleasures, some intellectual pleasures, and some accomplishment-inducing pleasures included in daily life. This might mean having a home that’s beautifully decorated with scented candles and filled with good food, a schedule that contains blocks of time for reading and massages, and a lifestyle containing hobbies and interests freely pursued. Then changes should be made so that new pleasures are constantly added (even if old pleasures are given up—as long as they’re not missed!), so that there’s a constant influx of non-habituated pleasure.


The following are different 'pleasures' that can offer a quick boost in mood. If you develop a lifestyle that includes several of these pleasures, you can create a more enjoyable, less stressful lifestyle for yourself. The trick is to vary the pleasures that you have in your life, and vary them often so that habituation doesn’t set in and rob them of their ‘pleasantness’.

Pleasures for Stress Relief

 

10 Diseases That Mimic Mental Illness

 

If you suffer from a mental illness such as anxiety, depression, bipolar disorder or schizophrenia, you may have an undiagnosed physical disease. Read on to discover why your mental illness could have a physical cause.

Thyroid Disease

Thyroid disease is a physical disease that can appear to be a mental illness. In hypothyroidism, there is an insufficient production of the thyroid hormone. Some of the physical symptoms include weight gain, cold sensitivity, thinning hair, dry skin, anemia, muscle aches & weakness. The mental symptoms include insomnia, hallucinations, suicidal thoughts and acts, depression, nightmares, paranoia, unstable emotions, suspiciousness and fear. In hyperthyroidism, there is an overproduction of the thyroid hormone. Some physical symptoms include weight loss, feeling overheated, diarrhea, infrequent or absence of menstrual periods, fast heart rate, shaking hands and hair loss. Mental symptoms include nervousness, insomnia, staring gaze, mood swings, impatience, hyperactivity, anxiety and depression.

Gluten Intolerance

Hidden gluten intolerance is a physical condition that can cause the symptoms of mental illness. Common physical symptoms of gluten intolerance include abdominal pain, diarrhea, constipation, weight loss or gain, hair loss and irritable bowel syndrome. Mental symptoms include behavioral problems in children, autism, Aspergers, learning disabilities, brain fog, anxiety, depression and even the symptoms of schizophrenia. In a person with gluten intolerance, gluten has an opiate effect on the brain, which can cause mental dullness and confusion.

Parasites Can Mimic Symptoms Of Mental Illness

A human parasite infection is a physical condition that can appear to be a mental illness. It is estimated that over 50% of Americans are infected with some type of parasite. Physical symptoms are numerous including chronic diarrhea/and or alternating with constipation, multiple food allergies, changes in appetite, sudden weight loss, muscle pain, sore intestines, muscle pain, gurgling intestines, anal itching, yeast infections, itching on the soles of the feet, foul-smelling gas, nausea/vomiting, dizziness, anemia, conjunctivitis (pink eye), palpitations and coughing up bloody sputum (in some cases). Mental symptoms include insomnia, anxiety/irritability, brain fog, depression and poor memory. You can find natural cures for parasites at my blog here.

Lyme Disease

Lyme disease is a physical disease that can appear to be a mental illness. Lyme disease is an illness caused by a bite from an infected tick. Early physical symptoms are usually flu-like symptoms, localized rash at the site of the bite, headache, fatigue and muscle aches and pains. Later physical symptoms include facial tics, pain or weakness in limbs, poor memory and concentration. Mental symptoms can include personality changes, symptoms of OCD, paranoia, fear, delusions on account of the effect Lyme disease has on the nervous system. If you have these physical and mental symptoms, get tested for Lyme disease immediately. Left untreated, Lyme disease can cause permanent neurological and mental damage.

Chronic Candida Infection

Chronic candida is a physical condition that can appear to be a mental illness. Candida is yeast that lives normally in the body. However, frequent use of antibiotics can destroy what keeps the yeast in check, which may result in an overgrowth. Some physical symptoms of candida are recurrent yeast infections, athlete's foot, stomach problems, craving for sweets and alcohol, acid reflux, low libido and itching. Mental symptoms include anxiety, irritability, restlessness, poor memory, brain fog, mood swings, manic depression, depression, delusions and psychosis. For more on chronic candida, including natural treatments, check out my article here.

Vitamin B3 Deficiency (Pellagra)

Pellagra is a physical condition that can appear to be a mental illness. A person with a vitamin B3 or niacin deficiency can exhibit physical symptoms such as muscle weakness, red scaly skin, loss of appetite and diarrhea. Mental symptoms can include dizziness, headaches and mental disturbances. Pellagra doesn't affect many in the US but is common throughout the world.

Vitamin B12 (Folic Acid) Deficiency

Folic acid deficiency is a physical condition that can mimic mental illness. It can occur after surgery that removes part of the intestine. This leads to malabsorption of the vitamin, which can cause physical symptoms such as weakness, paleness, mouth lesions and red sore tongue, restless leg syndrome, nausea & vomiting. Mental symptoms include moodiness, difficulty learning, anxiety, insomnia, problems with coordination, mania, hallucinations, paranoia and psychosis.

Hypoglycemia

Hypoglycemia is a physical disease that can appear to be a mental illness. Hypoglycemia means abnormally low blood sugar and it is a physical illness that mimics mental illness. Physical symptoms of hypoglycemia include weakness, shakiness, fainting and excess sweating. When blood sugar drops, mental symptoms can include anxiety, emotional outbursts, mood swings, excessive crying and the appearance of being under the influence of alcohol.

Heavy Metal Toxicity

Heavy metal toxicity is a physical condition that can appear to be a mental illness. Mercury, lead and arsenic are the most common culprits in heavy metal toxicity. Those with mercury fillings may be at risk. Also, heavy metal toxicity can result from what a person is exposed to at work or during leisure activities. Lead toxicity can lead to physical symptoms such as gastrointestinal problems, headache and convulsions with mental symptoms including anxiety, delusions, nightmares and mental confusion. Arsenic can also produce stomach and neurological problems as well as increased skin pigmentation and a garlic odor on the breath. Mental symptoms include dementia, apathy and anorexia nervosa. Those with mercury toxicity may have a metallic taste in the mouth, an overproduction of saliva, tremors and stomach complaints. Mental symptoms include depression, anorexia, irritability and psychosis.

Histadelia

Histadelia is a physical disease that can appear to be a mental illness. This is a physical condition characterized by too much histamine in the blood. Histadelia affects men more than women. It is estimated that 15-20% of patients who have histadelia have been inaccurately diagnosed with schizophrenia. Physical symptoms include frequent colds, allergies, fast metabolism, thin build, low pain tolerance and excessive sweating. Mental symptoms include strong suicidal tendencies, obsessions, mind blanks, severe depression, hyperactivity and phobias.

If any of the above physical conditions seem familiar to you and you believe you may be suffering from one, do more research and arm yourself with knowledge before going to see your doctor. It is important to get an accurate diagnosis of a physical illness to rule out mental illness.

 

The SUNDENE Protocol for Seasonal Affective Disorder 

  • Sun- for Sunshine or Sun Equivalent 
  • D- for vitamin D 
  • E- for Exercise 
  • N- for Nutrition 
  • E- for Everything else. E- for Everything else. There are many natural ways to help you feel better before jumping to anti-depressant medications (either Herbal or Pharmaceutical). Included in this protocol is humor for healing, meditation, Omega 3 and other natural supplements that offer the body the building blocks of serotonin. Anti Depressants are strong chemical medications the use of which may lead to more problems. Even herbal anti-depressants like Saint John’s Wort are chemicals. 

SAD can have debilitating consequences. If you struggle with depression, be sure to share this plan with the family and friends on your “support team” so that if you find yourself in an excessively dark and gloomy place this winter you can easily get some help to pull you out of the “hole”. Consult with a physician before self treating with natural anti-depressants or natural anxiety aids.

Although severe depression should also improve with this protocol, those experiencing moderate to severe depression should ALWAYS be working with their health care provider. Anyone experiencing thoughts of suicide should be under the supervision of a physician.

The following are the basics for my protocol for seasonal depression

“Sun” – We need 10,000 lux of light every day in order to produce enough serotonin to feel happy. This can be achieved by 15 minutes outside on a bright blue sky sunny day, or 1 hour outside when it is overcast. You may wonder “What in the world is a lux?” A lux is the light equivalent put off by one candle. So you can light 10,000 candles in your home to cheer yourself up (a bit of a fire hazard!) or you can just invest in a light box. 

A light box is an excellent idea for those with seasonal depression and is best used for twenty to forty minutes in the morning depending on the manufacturer’s recommendations to achieve the 10,000 lux equivalent.If you are unable to afford a light box you can simply try full spectrum light bulbs as these often provide enough light for those with mild to moderate seasonal depression.

Keep in mind also that outdoor places near water or snow are great to visit during the gloomy months of winter as the light is intensified as it is reflected back up to our eyes. If you are concerned about protecting your eyes from UV radiation, you can buy sunglasses with a clear lens, but that still provide UV filtration as it is the actual photons of light that our brains use and not the UV radiation to produce serotonin.

Those struggling with seasonal depression need to make an appointment with the sun or the sun’s substitute every single day. Topping off your serotonin levels by day means that more of this neurotransmitter will be available for conversion to melatonin (the hormone that keeps us asleep at night). Using light as a medicine should easily improve your sleep, leaving you more energetic for the following day.

“D” -Vitamin D is no longer considered a vitamin, but a “pro-hormone”. Exciting research about vitamin D is on the horizon, and some evidence supports a link to depression, although some studies do not support this link. Just about every patient I have ever checked in Seattle has been vitamin D deficient.

Vitamin D is produced in our bodies when UV light touches our skin. Most people living in the northern latitudes are easily vitamin D deficient if they do not spend 20 minutes outside each day. Elderly people have thinner skin, and thus produce less vitamin D, they also absorb less dietarily. Until further evidence supports this theory linking depression with low vitamin D levels, it only makes sense to be sure that you are at least not deficient in vitamin D.

The RDA for adults ranges between 200 IU and 600 IU. Food sources of vitamin D are milk, fish, and yeast. I typically recommend 1000 IU of vitamin D for my patients struggling with depression as a cheap and easy insurance policy that they are not deficient in vitamin D.

If you would like to have your levels checked be sure that your physician orders the “25-OH-D” as that is the most reliable indicator of vitamin D stores. Do not ever exceed 1000 IU of vitamin D unless under the care of your naturopathic physician. Dangerous side effects such as hypercalcemia can occur.

“E” -Exercise
- is the drug of choice for anyone that is depressed. It is a tough medication to take though when depressed because as best summed up by Newton’s laws of motion: “An object at rest stays at rest until acted upon by another force.”

When you are down in the depressed hole it is tough to get exercising, but stagnation is just going to perpetuate your problem.

Countless studies support the efficacy of exercise for depression. If you struggle with seasonal depression be sure to try to exercise outside EVERY SINGLE TIME the sun is out! Find a walking, running, or cycling buddy and take turns pushing each other out there. Whatever you do…just keep moving! Being cramped up in doors during the winter months is the problem and not the solution.

“N” –Nutrition is fundamental for anyone struggling with depression. When the body does not feel good the mind is soon to follow. Depressed thinking often results in poor dietary choices.

When we are depressed and in a low light setting we crave carbohydrates so that the body can produce more serotonin. However, sugar is exactly what the body does not need in the long term for healing from depression. The best diet for those with depression, anxiety, and bi-polar to follow is the LOW GLYCEMIC INDEX DIET.

Balancing out the blood sugar will help keep the mood at an even keel throughout the day. Be sure to eat protein with every meal and especially foods high in tryptophan such as turkey, cottage cheese, peanuts, fish, eggs, oatmeal, avocados, and bananas.

A high quality multi-vitamin will cover all the bases and ensure that you are not deficient in any of the B vitamins that are coenzymes for producing the neurotransmitters that make us feel happy.

“E” -For Everything Else
, E- for Everything else. There are many natural ways to help you feel better before jumping to anti-depressant medications (either Herbal or Pharmaceutical). Included in this protocol are "Finding Your Happy Place" <below> Humor for Healing, meditation, Positive Affirmations and Positive Thinking Omega 3 and other natural supplements that offer the body the building blocks of serotonin. Anti Depressants are strong chemical medications the use of which may lead to more problems. Even herbal anti-depressants like Saint John’s Wort are chemicals. And such as “Herbal Sedatives.” There are many treatment options for depression. Please do not give up hope.

Counseling, herbs, amino acids, and of course anti-depressants when need be will help keep you out of the “hole”. Naturopathic treatments for depression often take time as they are addressing the whole person and the long term.

Physicians give every treatment plans they write three to six months to determine its efficacy. If you are not experiencing improvement you may want to consider other treatment options. Various counseling and therapy techniques are also available, if you find you are not making progress with your therapist, consider a new referral for a different type of therapy. 

Remember that aside from physical and mental components, there is also a social component to seasonal depression. Much time spent inside, or repeatedly with the same people inside can contribute to a poor mood.

Schedule weekly activities to get you out of the house and interacting with others. If you live alone, the winter months can feel especially isolating. Find an elderly person that also lives alone to check in on, it will do you both a world of good.

If you enjoyed this post please feel free to leave a comment, share this information with those that might benefit and subscribe to future articles. Thanks for stopping by Mental Health Advocacy Inc!”
 

Find Your Happy Place
Smiling man

Little things that will boost your mood instantly

Many who have mental illness have been told their problems are too big. We want to feel better but we don’t quite know how to go about it.  Energy is important to health and happiness. Sorry to say, when we’re feeling blue, it can be hard to gather up the physical and mental energy needed to do the things that will make us feel better. Plunking down in front of the TV or digging into a tub of ice-cream seem much easier than planning a brunch party, weeding the garden, or pulling out a craft project. But research shows (and we know it’s true) that TV and ice-cream aren’t the ways to lift your spirits.

Try to look for patterns in the times of day when we begin to drag: are we having trouble getting out of bed in the morning? Passing out at our desk in the mid-afternoon? Dragging around our apartment after dinner instead of having fun with our families?  Sometimes, oddly, I’m too tired to go to bed: I can’t face the effort of brushing my teeth, washing my face, and then poof I wake-up on the couch in the morning with my back in knots. Once we’ve identified the energy dips in our daily routine, we will be able to identify strategies to keep our energy higher – and you’ll be astonished by how quickly and easily you will be able to give yourself a boost.

For long-term energy, it’s most important to a.) get enough sleep and b.) get some exercise. But that doesn’t help us get some energy right now. When we’re desperate for an immediate happiness boost, these are some tips that really work.

1.)  Go out into the sunlight – Light deprivation is one reason that people feel tired. We know that sunlight stimulates brain chemicals that improve mood. For an extra boost, get your sunlight first thing in the morning. And while you’re outside. . .

2.)  Go for a brisk walk – One study found that even a 10 minute walk is enough to increase energy and decrease tension.

3.)  Act with energy – We think we act because of the way we feel, but often we feel because of the way we act. Trick yourself into feeling energetic by moving more quickly, pacing while you talk on the phone, and putting more energy into your voice.

4.)  Listen to your favorite up-beat song – Hearing stimulating music gives an instant lift and is one of the quickest, most reliable ways to affect your mood and energy level. I’m always surprised by the effectiveness of this strategy.

5.)  Talk to an energetic friend – Not only do you gain energy from interacting with other people, but you also – in what’s called emotional contagion – “catch their emotions.” Instead of infecting others with your draggy mood, try to lift yourself by catching the energy of a boisterous friend.

6.)  Tackle an item on your to-do list – Unfinished tasks weigh you down. So if you feel bad about skipping your skin cancer check, not having completed an overdue report, or not having faced this month’s bills, force yourself to tackle one thing that’s nagging you. It is tough, but you’ll feel a huge rush of energy when you cross it off your list,

7.)  Clean up – I’m not sure why tidying makes such a huge difference, but when I feel like I can’t face the day I tidy up my desk, and I perk right up.

8.)  Humor – Use humor for healing grouchiness. Watch more comedies read joke books and the jokes in magazines. Find something funny and clip it out to post somewhere near you. You should even try to find the humor in serious situations like a slip in a presentation or mispronouncing a word just laugh it off and move on.

Here are some other ideas grouped by category to try.

Fun

·         Add a fun thing to your calendar such as trying a new recipe.

·         Better, add a fun thing to your calendar that involves other people. For instance, I have a friend who loves Gaming Cards as much as I do, and every once in a while we plan an  outing to go find better cards.

·         Best, add a fun thing to your calendar that involves other people and has you doing something outdoors. Studies show that just being outside in the sunshine helps boost your sense of focus and good cheer.

Challenge

·         Think of a subject that you wish to know about (be honest – something that really interests you) and spend 15 minutes on the internet reading about it.

·         Take a step towards acquiring a new skill you’d like to have – Italian Classes in your neighborhood of Photo Shop classes on line. Research it and investigate it to be able to follow-through with it.

·         If you really can’t think of one single subject that interests you , visit a couple of book stores ( used book stores are great for this) and browse until some book or topic catches your  attention. Then you can either buy the book of go back home and research the topic on line.

Doing Good, Feeling Good

·         Sign up to be an organ donor (don’t forget to tell your family that you’ve chosen to do so). Many people get a great sense of goodness knowing that they will be helpful even beyond death. You may, quite literally, have a chance to change the world after death by donating your eyes to a children’s hospital. 

·         Write a check – even a small one – for a good cause. Many of us, who are on a fixed income, have a sense of financial helplessness but if we can just give that “widow’s mite” we will feel better about ourselves and our situation. 

·         Sign up to volunteer for or participate in an organization that furthers a cause you value. We might not have money but most of us have time on our hands. If you can work it out you will feel better knowing you are contributing to something worthwhile.

Order your life

·         Clear out space around your computer

·         Clean out your closet

·         Walk through your house with a garbage bag and clear out all the clutter until the trash bag is full. Then walk around with a new bag with things to be given away or sold at a yard sale. Repeat

Banishing Guilt

·         Reach out to a family member that you’ve been neglecting.

·         Make something right: apologize, confess, replace – or return something you’ve borrowed.

Being a good citizen

·         Throw away someone else’s litter

·         Be helpful with an elderly person or a person with small kids.

·         Be friendly to a store clerk who seems grouchy

To feel happier quickly, it helps to remember that you have to “burn energy to create energy.” When I’m at my most sluggish, apathetic, and gloomy, I can often kick myself into gear by burning some energy: running up the stairs, singing out loud, doing a whirlwind tidy-up of our apartment, or crossing some nagging task off my list. Counter-intuitively perhaps, these exertions don’t drain me even more. Instead they furnish a much-needed surge of energy.

By pushing yourself to burn a little energy by tackling a task, you’ll give yourself a shot of energy and cheer. If you can’t do a big task start with something small or divide the larger task into several small tasks. Even one step in the right direction will give you a lift.

I love this quote by Dag Hammarskjold from his book Markings: “Do not look back. And do not dream about the future either. It will neither give you back your past, nor satisfy your other daydreams. Your duty, your reward – your destiny – is here and now.” Happiness is always in the here and now? 

 

How to stay on the brighter side of life  - Marc Jacques

 Happiness is a choice – one we make every day. 

                                                                                                                                 - Joel Osteen - Televangelist  

Find the gift in each day

How you start your day is going to determine what kind of day you have. Instead of waking up and thinking, “I don’t want to work today,” focus on positive things like coming home to your family or a fun lunch with your colleagues. Be thankful for the day. If it is raining be thankful that the flowers and trees are getting water.  Snowy and cold be thankful that there will be less biting insects next year. Find that gift in every day. 

Don’t give away your power

Don’t make a big deal over something that is not a big deal. Every day we have plenty of opportunities to get angry, stressed or offended. We risk our mental health when we indulge these negative emotions. This is because we are giving something outside ourselves power over our happiness. You can choose not to let little things upset you. One technique is to think about how a bad situation might be keeping you from a worse situation.  I was in a traffic jam because of a car crash up ahead when I realized if I had been only minutes earlier I would have been part of the car accident and not looking at it.   

Know whom to ignore

Protect your mental health by saving your effort for resolving conflicts with those you cherish.  A disagreement involving someone who is not that important to you, like a guy that cut you off in traffic or a rude cashier is something that should just role off your shoulders. Ignore their negative mental energy; instead just wish the other person well and avoid visualizing something bad happening to them. Save your problem-solving energy for helping with more significant things like family and friends. 

Be a Victor and Not a Victim

Are you going through bad times? Some will just say, “That’s life.”  But others say, “Nothing happens to you, it happens for you.” See the positive in negative events. Yes I have schizophrenia, but now that I am doing better I can share how I overcame my illness which will help others have an easier time of it. Staying mindful of the positive you will be able to keep away from feeling like a victim and enjoy optimism. 

Celebrate others successes

A very important way to protect our mental health is by celebrating the successes of others.  Unfortunately, we live in a culture that relishes tearing others down. Don’t give in to what you are seeing on TV. Peer support is about helping others who are just like we are. At the end of the day, it is way more fulfilling to help people reach their goals. Instead of feeling jealous over someone’s success, remember, if they have the same mental illness as I do and they are successful that gives me hope that I can do better and better.

 

 

RECOVERY: DEFINITION & COMPONENTS

Since the mid-1980s, volumes of information have been generated about mental health recovery from the perspective of consumers (people who buy mental health services with either public or private insurance), family member and mental health professional. The amount of research of various aspects of recovery continues to grow exponentially. Early research by Courtney Harding (1987) and others challenged the belief that severe mental illness is chronic and that stability is the best one could hope for. They discovered there are multiple outcomes associated with severe mental illness and that many people did progress beyond a state of mere stability. As such, the concept of recovery began to obtain legitimacy (Sullivan 1997). Now the experience of recovery is common knowledge and the remaining work is how to get our nations’ and indeed the world’s Public mental health to change to recovery orientated systems of care.  

Early on, there are many perceptions and definitions of recovery, William Anthony, Director of the Boston Center for Psychiatric Rehabilitation seems to have developed the cornerstone definition of mental health recovery. Anthony (1993) identifies recovery as " a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and/or roles. It is a way of living a satisfying, hopeful, and contributing life even with limitations caused by the illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness."

 

Ultimately, because recovery is a personal and unique process, everyone with a psychiatric illness develops his or her own definition of recovery. However, certain concepts or factors are common to recovery.  Some of these are listed below.

More recently, SAMHSA released a consensus statement outlining 10 fundamental components of recovery.

Recovery emerges from hope:  The belief that recovery is real provides the essential and motivating message of a better future – that people can and do overcome the internal and external challenges, barriers, and obstacles that confront them. 

 

Recovery is person-driven: Self-determination and self-direction are the foundations for recovery as individuals define their own life goals and design their unique path(s). 

 

Recovery occurs via many pathways:  Individuals are unique with distinct needs, strengths, preferences, goals, culture, and backgrounds including trauma experiences that affect and determine their pathway(s) to recovery. Abstinence is the safest approach for those with substance use disorders.

 

Recovery is holistic:  Recovery encompasses an individual’s whole life, including mind, body, spirit, and community. The array of services and supports available should be integrated and coordinated.

 

Recovery is supported by peers and allies: Mutual support and mutual aid groups, including the sharing of experiential knowledge and skills, as well as social learning, play an invaluable role in recovery .
 

Recovery is supported through relationships and social networks:  An important factor in the recovery process is the presence and involvement of people who believe in the person’s ability to recover; who offer hope, support, and encouragement; and who also suggest strategies and resources for change. 

 

Recovery is culturally-based and influenced : Culture and cultural background in all of its diverse representations, including values, traditions, and beliefs are keys in determining a person’s journey and unique pathway to recovery. 

 

Recovery is supported by addressing trauma : Services and supports should be trauma-informed to foster safety (physical and emotional) and trust, as well as promote choice, empowerment, and collaboration. 

 

Recovery involves individual, family, and community strengths and responsibility:  Individuals, families, and communities have strengths and resources that serve as a foundation for recovery.

 

Recovery is based on respect :  Community, systems, and societal acceptance and appreciation for people affected by mental health and substance use problems – including protecting their rights and eliminating discrimination – are crucial in achieving recovery. 

 
December of 2011 A new working definition of recovery from mental disorders and substance use disorders had been announced by America’s Substance Abuse and Mental Health Services Administration (SAMHSA). The definition is the product of a long effort by SAMHSA and a wide range of partners in the behavioral health care community and other fields to develop a working definition of recovery that captures the essential, common experiences of those recovering from mental disorders and substance use disorders, along with major guiding principles that support the recovery definition. SAMHSA led this effort as part of its Recovery Support Strategic Initiative.

The new working definition of Recovery from Mental Disorders and Substance Use Disorders is as follows:

“A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. “

“Over the years it has become increasingly apparent that a practical, comprehensive working definition of recovery would enable policy makers, providers, and others to better design, deliver, and measure integrated and holistic services to those in need,” said SAMHSA Administrator Pamela S. Hyde. "By working with all elements of the behavioral health community and others to develop this definition, I believe SAMHSA has achieved a significant milestone in promoting greater public awareness and appreciation for the importance of recovery, and widespread support for the services that can make it a realityfor millions of

Americans.

 

Mental Health Recovery

as in the NCMJ May/June Volume 73 No.

By Debra Dihoff and Michael Weaver

North Carolina has new opportunities for orienting its mental health care system toward client recovery as the system shifts to managed care with the possibility of offering more innovative services. Ways of accomplishing this reorientation are explored and instances of progress are noted.

Recovery is quite the mental health buzzword these days. But recovery is more than just “the process of combating a disorder” [1]. What are the essential components of mental health recovery? And what opportunities currently exist for changing our mental health care system in ways that will promote recovery?

A group of experts convened by the Substance Abuse and Mental Health Services Administration (SAMSHA) in 2004 produced the following consensus statement on recovery:  “Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.”

The consensus statement goes on to describe 10 fundamental components of recovery:  (1) Recovery is self-directed; those with illnesses “lead, control, exercise choice over, and determine their own path of recovery.” (2) Recovery is individualized and person-centered. (3) The person in recovery is empowered “to choose from a range of options and to participate in all decisions.” (4) Recovery is holistic; it “encompasses -  mind, body, spirit, and community - and embraces all aspects of life.” (5) Recovery is nonlinear; it is “not a step-by-step process but one based on continual growth, occasional setbacks, and learning from experience.” (6) Recovery is strengths-based, building on the “capacities, resiliencies, talents, coping abilities, and inherent worth” of the person in recovery, rather than focusing on correcting deficits. (7) Peer support and the sharing of experiential knowledge encourage recovery. (8) The per-son in recovery deserves respect, acceptance, and appreciation. (9) The individual takes responsibility for his or her own self-care and recovery. (10) Hope is “the catalyst of the recovery process.”

Recovery is a way of thinking that can be adopted both by the individual in recovery and by the mental health care system. It differs greatly from the approach of having an expert, generally a psychiatrist, control and direct the treatment. In fact, it turns that approach upside down by putting the person with the illness at the center of all decisions. Professionals are part of the recovery team, but they function more as consultants. Services and supports become oriented around what really works for the consumer, based on his or her strengths.

Recovery Stories

At age 36, Jon returned home to live with his parents after having spent many years living in low-income housing or on the streets, with periodic enrollment in college. As a person living with schizophrenia, the voices he heard and the tactile hallucinations he felt were so troubling to him that he could not tolerate being around people. By the time he moved back in with them, Jon’s parents had graduated from the National Alliance on Mental Illness (NAMI) Family-to-Family psycho-education program. Jon underwent peer training and is now working 24 hours a week as a recovery educator and peer support specialist. He has overcome his fear of crowds and of driving on the highway. He makes presentations to audiences frequently and enjoys being in a band. The costs to the system are much less (eg, he has had fewer hospitalizations and trips to the ED, and fewer police interventions), and his family is paying less of an emotional cost. Jon is recovering.

Janice had dyslexia early in life and did not to learn to read until she was in her 20s. Her learning difficulties were compounded by bipolar disorder and substance abuse. She was put into group and foster homes because of her behavior and was restrained and secluded frequently. She had 4 children and lost custody of them all. At age 40, she started to experience hope and began her recovery journey when she began to attend classes to learn more about her illness. She became a peer support specialist and now serves on a NAMI affiliate board. She learned how to drive and got a full-time job. Now, at age 46, she owns a house and a car, has gotten married, and has regained custody of most of her children. She has decreased her dependence on public services and manages her own recovery.

George’s life was decimated by a troubled home life, schizophrenia, and crack cocaine use. During inpatient treatment, he was frequently restrained and put into seclusion, which aggravated his symptoms. Finally, he was exposed to a self-advocacy approach and learned how to make a recovery plan that included managing his symptoms. (Recovery plans are written by the person with mental illness. The plans typically include strategies to keep the person healthy, as well as tactics to identify and de-escalate situations that can exacerbate symptoms of their illness.) He has become a leader in promoting a system based on ideas of hope, empowerment, education, choice, and support. He is a leader in government and advocacy organizations. He still receives publicly funded mental health care, but at a minimal level.

These 3 individuals are experiencing recovery because of effective professional intervention and the existence of role models of recovery in their communities. One of the beliefs that supports self-directed recovery is that people need to see recovery as part of their lives, and to do this, “they need to be surrounded with possibilities of recovery” [3].

Opportunities to Create a Recovery-Focused Mental Health Care System in North Carolina

By 2014 North Carolina will have made changes to com-ply with the Affordable Care Act. In addition, because of state legislative changes, its mental health care system will have transitioned to a fully capitated, managed care model. What are the opportunities to move toward a system that supports recovery? In order to live within their capitated budgets, managed care organizations (MCOs) will be motivated to provide services and supports that help people get well and stay well. Under the old fee-for-service system, billing had no capitated limit each year. The new system will offer an incredible opportunity to make recovery the focus of care by giving the people who need help a personal stake and role in maintaining their own recovery. Lessons learned from people like those in the stories above can be applied.

Reinvestment of savings : MCOs must manage their state and Medicaid funds in order to achieve the best possible health for those in need within a capitated amount. They must pay for all of the needs of the population within their region with that pot of money. What a terrific opportunity this presents for moving from a provider-defined system to a system that compiles data about which services really work and which providers achieve the best outcomes. In this new system, the MCO can attract high-quality providers because they can pay them more and can limit the total number of provider contracts. Since there will be fewer providers, the communication between the MCO and provider will be enhanced. If the contracted providers support recovery, they will have more successful outcomes. It will be difficult to shift priorities and sever old contracts in favor of services and providers that are focused on recovery, but doing so is essential to achieving this vision. The MCOs will have the tools to restrict the number of providers and to adjust rates; these are big changes. Former LMEs that convert to MCOs will have to deter-mine which services will help promote patient self-directedness, empowerment, and responsibility, as well as the other characteristics of recovery. People with mental ill-nesses want decent housing, and for many of them jobs are both necessary and appropriate. Hospitalizations must be planned for, but in the community, recovery services are most important—and most lacking. Supported housing, employment, psychoeducation (to help patients and their families better understand their illness), and specialized peer support are services that MCOs should endeavor to add to their array. Previous rules prevented spending funds on housing per se, but with the opportunities afforded by managed care, savings from a better-managed system can be reinvested in housing. Ensuring that people with mental illness have safe and affordable housing greatly contributes to stability; doing so results in savings, as does helping people avoid hospitalization. If money is spent to support people in finding and keeping jobs, everyone wins. People who were once consumers of government subsidies achieve taxpaying status. Trained individuals who have experienced mental illness are paired with people who have recently been hospitalized or have spent time in jail or prison, and help them transition back to wellness. No one can offer credible, relevant assistance as well as someone who has been through the same thing. The freedom to adjust rates is one of the tools avail-able to MCOs. Instead of paying providers based solely on the number of visits, the MCO can reward those providers who achieve the best outcomes by paying them at a higher rate. MCOs should also contract only with those providers who do a good job of keeping people at home (out of the hospital and out of jail) and helping them find jobs, decent housing, and meaningful relationships. This is a win-win-win approach for those living with an illness (who get to live as they wish, rather than being confined), for the MCO (which saves money by avoiding unnecessary hospitalizations), and for the providers (who get paid at a rate commensurate with their performance).The MCOs can also examine local conditions to see what needs to be changed. Trying to find out why the same people cycle in and out of hospitals or jails would be a great place to start; then the MCO could try to design a system that would break those cycles. Changes that might help accomplish that include providing housing supports and case management services in addition to ongoing medication and therapy. Sometimes people land in a hospital bed because they couldn’t afford to refill a prescription.

Provider monitoring:  

North Carolina’s mental health care system needs to take definite steps to ensure that providers are offering recovery-focused treatment. Provider monitoring should include some examination of whether recovery principles are being adhered to; tools such as the Recovery Oriented Systems Indicators Measure (ROSI) which includes both a consumer self-report survey and an administrative-data profile, can be useful in this regard. Feedback from people living with mental illness and their family members can be a useful measure of the success of providers in establishing a recovery organization. Here are some questions monitors may want to ask: Does the provider organization include people with mental illnesses or their family members on its board of directors or its staff? Are paid peers among those providing services? Do staff and board members understand and accept recovery principles? Do treatment plans reflect a consumer-driven process? Are all printed materials and policies aligned with recovery principles? Are the recipients of services interviewed about whether their treatment has been based on the 10 principles of recovery? Both the funder (the state) and the provider organizations themselves should be interested in knowing the answers to these questions. A focus on recovery must be reflected throughout the agency—in its policies, the com-position of its board, and the way its staff members interact with consumers. The ultimate measure is how well the per-son receiving services has been supported in finding his or her own path toward wellness.

Progress in North Carolina

North Carolina is definitely making progress in orienting its mental health care system toward recovery. NAMI North Carolina offers free to family members and those living with mental illness a number of psychoeducation programs and support groups—including Connection, a NAMI support group run by people who are themselves living with mental illnesses. The peer-to-peer psychoeducation program helps people develop a crisis plan that serves them well; the cri-sis plan can include the development of their own advance directive, in addition to other general recovery strategies. We are beginning to see more paid peer support specialists throughout the North Carolina system. It is encouraging that a peer support specialist was recently hired at Cherry Hospital; now the other state hospitals need to follow suit. There are a number of wellness centers and recovery centers in the state that offer psychoeducation and other educational programs. There is talk of including recovery language in the statutes defining mental health services in North Carolina. A legislative study commission is considering a requirement that local MCO boards contain consumers of behavioral health care and their family members. And under the managed care Medicaid waiver, MCOs can offer a Medicaid-reimbursed individual peer-support service. The North Carolina Division of Mental Health, Developmental Disabilities, and Substance Abuse Services contracted with the Behavioral Healthcare Resource Program at University of North Carolina at Chapel Hill to manage the North Carolina Certified Peer Support Specialist program. From February 2007 through February 2012, a total of 649 individuals were certified, roughly 47% of whom were living in recovery from a mental illness; another 38% were living in recovery from a substance abuse disorder, and l5% were living in recovery from both a mental illness and a substance abuse disorder. These peer-support specialists have widely varying educational backgrounds. Half (50%) have a high school diploma, 7.3% have a GED, and 2.9% are not high school graduates. The remaining peer-support specialists have education beyond high school. Specifically, 5.6% have an associate’s degree, 4.1% have some college, 22.5% have a bachelor’s degree, 5.5% have a master’s degree, and l.7% have a doctoral degree. Only 55.6% of the total number of peer-support specialists are employed, so there are many certified individuals who could be hired by providers to further the use of recovery techniques in their agencies. Figure l shows how many trained peer support specialists live in each county in the state [4].Meeting the goal of orienting North Carolina’s mental health care system toward recovery will take time; it is a lengthy process, not to be achieved by a certain date. But we must work toward that goal by holding the Division of Mental Health, the MCOs, and providers accountable for reshaping the system to adhere to the 10 principles of recovery. And perhaps the most important task of all is to involve those with illnesses in directing their own recovery.

Debra G. Dihoff, MA executive director, National Alliance of Mental Illness (NAMI) North Carolina, Raleigh, North Carolina.

Michael Weaver, MS Ed executive director, Mental Health America of the Tar River Region, Rocky Mount, North Carolina, and member, NAMI Board of Directors, Raleigh, North Carolina.

Acknowledgments

Debra Dihoff is an employee of NAMI North Carolina, a nonprofit organization that receives 57% of its budget from state and local government, 21% from donors, 9% from foundations and corporations (including Astrazeneca, Bristol Myers Squibb, Lilly, Janssen, Triangle Community Foundation, Community Health Foundation, among others), 6% from fees, and 7% from other sources. Mental Health America of the Tar River Region receives roughly 50% of its funding from the Beacon Center, with the remainder coming from private donors. Ron Mangum of the Behavioral Health Resource Program at the

University of North Carolina at Chapel Hill helped us by providing information on the number, location, and experience level of certified peer support specialists in North Carolina. The program’s Web site is referenced, and a map from that web site serves as Figure l. Potential conflicts of interest. D.G.D. and M.W. have no relevant conflicts of interest.

References

1.   Merriam-Webster’s online dictionary. http://www.merriam-webster.com/dictionary/recovery. Accessed April 23, 2012.

 

2.   Substance Abuse and Mental Health Services Administration, US Department of Health and Human Services. National Consensus Statement on Mental Health Recovery; 2006. http://store.samhsa.gov/shin/content//SMA05-4129/SMA05-4129.pdf. Accessed April 23, 2012.

3.   Building a Foundation for Recovery: A Community Education Guide

 

on Establishing Medicaid-Funded Peer Support Services and a

Trained Peer Workforce. Center for Mental Health Services, Sub-stance Abuse, and Mental Health Services Administration, Rock-ville, MD; 2005:8. DHHS Pub. No. (SMA) 05-8089). http://www

.mhrecovery.org/var/library/file/35-Peer%20Support%20Cmmn

ty%20Guide.pdf. Accessed April 23, 3012.

4.   Behavioral Healthcare Resource Program Web site, Web page for

North Carolina’s Peer Support Specialist Program. http://pss-sowo

.unc.edu/pss Accessed April 23, 2012.

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