What is "great" about the Georgia Recovery-Based Educational Approach to Teaching, in addition to its acronym, is the sense of hope it fosters among psychiatric patients by making them full partners in their own care rather than passive recipients of symptomatic treatment, P. Alex Mabe, Ph.D., says.
In fact, shared decision-making and empowerment are the lynchpins of the psychoeducational model, which recently earned the 2012 Award for Creativity in Psychiatric Education from the American College of Psychiatrists.
Courtesy Gareth Fenley, Project GREAT
Dr. Alex Mabe presents to psychiatry residents on "Shared Decision Making."
Project GREAT, conceived by Dr. Peter F. Buckley, former chair of the department of psychiatry and health behavior and current dean of the medical college at Georgia Health Sciences University in Atlanta, is a recovery-oriented treatment program designed to not only change the nature of patient involvement in their own care, but also to change the way in which providers think about treatment, said Dr. Mabe, faculty leader of the program.
Recovery-oriented treatment programs – those that focus on promoting the ability of individuals to cope with their mental illness and to recover meaningful roles and quality of life in the community – began to emerge in the late 1980s. But Project GREAT is among the first to attempt to change clinical services and educational curriculum, Dr. Mabe said. Specifically, the project comprises both an educational/curriculum development and a treatment component, he said.
With respect to provider education, the team has developed a workshop curriculum made up of role plays, live and video presentations, and interactive discussions created and presented by providers and patients working together, Dr. Mabe explained. "Psychiatrists and psychologists teach along side certified peer specialists (CPS) – individuals who have experienced the disabling symptoms of severe mental illness and have gained control over their lives."
Through the multimedia presentations, workshop participants gain an understanding of the recovery model and obtain the tools to put the concepts into practice immediately, including the pre-assessment process, intake interview, and follow-up appointment documentation that stresses self-directed treatment planning and a focus on strengths and hope rather than on psychopathology and symptoms, he said.
"Conventional psychiatry has tended to focus exclusively on diagnosis and symptom treatment, without a consideration of well-being and overall quality of life," Dr. Mabe said. "Through Project GREAT, our goal is to empower patients to gain some measure of control over their lives and to have meaningful goals."
Toward this end, the treatment component of the program is built on shared decision making. In this regard, the CPS members of the treatment team are mission-critical. Their role is tri-fold: provide direct support to patients; educate and provide feedback to residents and other providers with respect to listening to, collaborating with, empowering, and fostering a partnership with patients; and represent the project in the community through participation on advisory boards.
By sharing their own stories, the treatment team members help to dispel patients’ negative self images, an all-too-frequent byproduct of societal stigmatization of mental illness, he said.
"Through Project GREAT, our goal is to empower patients to gain some measure of control over their lives and to have meaningful goals."
"Because these specialists have themselves successfully engaged in the recovery process, they are able to instill hope in the consumers in a more powerful way than someone who has not been on that journey would be able to, including providers."
Time and resource restraints are often cited as obstacles to new program acceptance, but "there is no difference in the treatment course or duration between Project GREAT and conventional care," Dr. Mabe said. The differences lie in the underlying philosophy and the nature of its implementation.
"Financially, the main economic question will center around the peer specialists and whether they can be sustained in terms of their own income," he said. "Many states have funding through Medicaid, but the rates are fairly low at this point. Although we haven’t yet done a financial assessment of the program, which we began in earnest in 2007, it’s easy to see how recovery-based care in the long-run will reduce recidivism and actually make systems more efficient."
Curiously, although initial skepticism among providers that a recovery-based treatment approach is feasible in mental health practice is among the implementation challenges, one of the more stubborn obstacles is the pervasive stigmatizing attitudes that providers have toward their patients, Dr. Mabe said. "Unfortunately, the research is quite clear that providers still have trouble being hopeful about outcomes, particularly with people who have serious or chronic mental illness."