In Winston-Salem, a community-first approach to mental illness - North Carolina Health News
By Yen Duong
“Lord, please connect me to the people and the resources that is going to help me to become all that you have created me to be.” Around 2 a.m. on April 7, 2008, Pam Goodine called out a prayer to overcome her drug addictions, which she had been unable to do through incarcerations and treatment facilities.
That prayer was projected on a screen last week at GreenTree Peer Center, a community education center in Winston-Salem for people with mental health and substance use issues which does exactly what Goodine was asking for.
Goodine has been drug-free for 11 years and now works full-time as a peer support specialist for Forsyth County. She also trains peer support specialists at GreenTree. As a peer support specialist, Goodine shares her experiences with incarcerated women and helps them to create plans for after their release into the community and to connect with resources.
With an emphasis on community inclusion and peer support, GreenTree’s model of support marks a shift toward “mental health recovery” rather than the usual model of using medications to adjust brain chemistry and manage symptoms, said Laurie Coker, director of GreenTree.
“We know sometimes its brain changes that trigger symptoms, but a lot of times, the brain changes are actually a result of extreme emotional trauma, literally changes that happen because of what we experience,” Coker said in an interview. “The way that the world is moving, and we are kind of behind on this, is toward looking at how do you help people focus on what they can do themselves to help their lives get better.”
GreenTree Peer Center
Late last month, about 35 attendees, including staff from Cardinal Innovations, community members, workers from the Department of Health and Human Services and advocates visited GreenTree, a squat building on the outskirts of downtown Winston-Salem. They came for a presentation of photos taken by GreenTree members and a speech by Coker.
In addition to promoting self-expression, the center’s PhotoVoice project measured the level of community participation of its eight subjects, said Chinyu Wu, a professor at Winston-Salem State University who ran the study. The participants received point-and-shoot digital cameras and three photo assignments “to voice their experiences [and] to share their worldview,” Wu said. At feedback meetings, the participants discussed how the photos touched on their community, work, identity, spirituality and family.
Afterward, with Goodine’s prayer on the wall, Coker referenced county data showing fewer hospitalizations. She said many GreenTree members who had been hospitalized multiple times in the past were being admitted to the hospital less frequently. Of those who still end up in the hospital, “they don’t stay as long, because they know what they’re going back out to, they know they’ve got community to go out and connect with,” Coker said.
What started as biweekly coffee get-togethers of people with mental health disorders has grown into a full-fledged community of advocates, supporters, people with mental illnesses, Coker said.
“One of our participants, all they want to be able to do is go to a sit-down restaurant where they get waited on, because they hadn’t eaten in a place like that in seven years,” Coker said. “The thing is, even little small steps that we may take for granted, these are a big deal for folks.”
Community as ‘the first step’
Many approaches to mental health involve using medication to manage symptoms. In contrast, this mental health recovery model integrates people with mental illnesses back into their communities first to encourage and support recovery, said Mikayla Leffin, an attendee from the North Carolina chapter of the National Alliance on Mental Illness.
“Traditionally, with recovery, you get your medication first, you find your therapist that works, and then maybe you incorporate in the community,” Leffin said. “But what we found evidence-based is that… community participation actually encourages people to take their medication and find their therapy. And that’s actually the first step, not the last step.”
GreenTree is one of four pilots from the i2i Center for Integrative Health’s “I’m IN: Community Inclusion” statewide project, which began in 2018. The other beneficiaries are an educational collaborative in Johnston County, a “meet your neighbor” event in Raleigh and a series of day-long events in Forest City.
“[The goal is] to try to encourage local grassroots groups across the state to invent new ways of including people with serious mental illness in their communities in meaningful ways,” said Michael Owens, the project manager for “I’m IN.” “It sounds sometimes like a simple idea, but it is not a simple idea.”
The i2i center will run a standalone conference next spring to stir up more interest in community inclusion, and the organization is applying for grants to fund more pilot projects, Owens said. The current funding for the four pilots comes from the Mental Health, Developmental Disability and Substance Abuse Services Division of DHHS.
“This is one of the only mental health recovery initiatives our state has ever tried,” said Coker.
Most of the evidence-based ideas for community inclusion come from Temple University in Philadelphia. On Dec. 3, Mark Salzer from Temple will come to DHHS to continue training on marketing and connections with the pilot sites, NAMI affiliates and others, said Michelle Laws from MH/DD/SAS.
“Part of community inclusion success is dependent on having this broad reach of partners within communities that created an inclusive environment,” Laws said. “No matter how much self-efficacy or agency I have, if I go into a community and I’m like, ‘They’re really not welcoming of me …’ then I probably will go back to my home or stay isolated within my own little small area of community.”
‘Hope is possible’
Advocates for the community inclusion model cite how factors of health such as housing, education and transportation better reflect the social aspects of human beings. Goodine, the peer support specialist, is certified in a national program to help people recover and runs 40-hour trainings for aspiring peer support specialists at GreenTree.
“We all face some type of challenges, some kind of struggle, which may bring about some uncomfortable feelings and cause us to do some things (that are) not healthy for us,” Goodine said.
“By identifying with those stresses or triggers are, we are able to create an action plan [so that] in the case these things happen, we don’t have to respond the way that we used to.”
With concrete steps and plans in action for change, people guided by peer support specialists may have more success at recovery, as in Goodine’s experience.
“I only learned more about mental health when I became a peer support specialist and I began listening to other people,” Goodine said. “When I heard about peer support specialist, I said, ‘I want to do this, I want to go out and help those people that are struggling. I want to be able to self-identify and let them know that hope is possible.’”