Wellness Self-Management (WSM) is a curriculum-based clinical practice designed to assist adults to effectively manage serious mental health problems. The WSM program was based on Illness Management and Recovery (IMR), one of the nationally recognized evidence-based practices for adults with serious mental health problems.
In 2003-2006, the New York State Office of Mental Health (OMH) participated in a Substance Abuse and Mental Health Services Administration (SAMHSA) sponsored initiative to implement and evaluate IMR. As a result of the feedback and experience of participating consumers, practitioners and administrators, OMH, in partnership with the Urban Institute for Behavioral Health, developed and evaluated the WSM approach. WSM incorporated many of the recommendations of participants as well recommendations of the OMH Office of Recipient Affairs. The recommendations included: (1) Change the name to emphasize the positive goal (wellness) and the central role of self-management; (2) Expand the curriculum to include physical health issues; (3) Organize the materials into a bound personal workbook that belongs to the learners; (4) Use language that reflects recovery principles of choice, hope and shared decision making; and (4) Design a group format that corresponds to the workbook and provides a useful and easy to follow framework for facilitating a curriculum based program.
The WSM workbook consists of 57 lessons and includes topics such as:
- What helps and what hinders recovery
- How having goals helps recovery
- Practical facts about mental health symptoms, treatment, and causes
- How social support and using community resources help recovery
- How family and friends can support your work in WSM
- Developing and using a relapse prevention plan
- Finding and using coping strategies that work
- Knowing and using your strengths to support recovery
- How your cultural and family background affects decisions about mental health services
- Understanding the connection between physical and mental health
In the fall of 2007, OMH conducted leadership forums to inform and engage mental health provider organizations to determine their interest in participating in a statewide initiative to implement Wellness Self-Management. The response was very gratifying with over 100 agencies including ACT, residential, continuing day treatment, clinic, PROS, VA programs, forensic and inpatient treatment programs choosing to participate in the initiative.
To support the participants, OMH, in collaboration with the Evidence Based Practices-Technical Assistance Center (EBP-TAC) at Columbia University, organized agencies into regional learning collaborative that included quarterly face to face meetings with key individuals in the participating programs, supervisory and line staff training sessions; monthly phone calls and data collection and analysis of a number of performance indicators.
Over one year later, 95% of the agencies remain actively committed with many expanding WSM in their initial startup programs and actively spreading or planning to spread WSM to other programs in their respective agencies. Since initial implementation of WSM in the spring and summer of 2008, over 250 groups are up and running with over 2500 consumers participating. We anticipate that as many as 3000 consumers will have completed or be enrolled in a WSM program by the end of 2009.
In addition to the high percentage of agencies that have remained active participants in the learning collaborative, a high percentage of consumers continue with WSM after beginning the program. Of all consumers who have ever enrolled in a WSM group since the program began nine months ago, approximately 65-70% continue to be involved.
The WSM program provides benefits to participants, mental health staff and administrators. For program participants, WSM provides consumers with research informed information and tools to better manage mental and physical health problems. This enables individuals to spend less time managing illness and more time pursuing goals and enjoying life. WSM is also designed to reinforce principles of recovery including shared decision-making, informed choice, involvement, and hope.
WSM participants comments: “I was very angry; I wasn’t dealing with it. I wasn’t taking my illness seriously. Now I decided to start taking my meds on time and not skip it;” “I thought I could never handle a job but now I’m looking forward to getting a job;” “It helps pinpoint symptoms. I can feel the storm coming and prevent it from happening;” “I asked my mom to help me with the WSM book. I told her about the program … it gives me a push to keep going;” “It’s about you… nobody is pushing you or forcing you… it’s about you doing what right for you;” “This group gives me tools I can use … different from other groups;” “I like the cultural background part. It doesn’t violate your cultural background.”
WSM benefits for mental health staff: The WSM curriculum, materials, consumer workbook, and corresponding training integrate a number of core clinical skills. These include motivation enhancing strategies, basic cognitive-behavioral approaches, teaching techniques, and practical group leadership skills. WSM is designed to support clinical staff in providing WSM services in group and individual modalities.
What staff facilitators say: “At first I was skeptical about this group because we start lots of groups. … I noticed that the consumers were really listening to this and using the stuff they say in the group. … More and more clients are telling their friends about it, and they want to join. Even the psychiatrists want to see the workbooks;” “Running the group has affected me. I have been able to step out of my position for a moment and understand what they have been going through. … I am learning from them and they are learning from me, we are both growing;” “Clients actually have something to look forward to. People are alive and alert … up and active;” “It’s really helpful because until now, they didn’t have anything they could take home. People have the book now. Consumers talk about how they were able to sit down with the psychiatrist and therapist and ask questions.”
Benefit for mental health agencies: WSM provides a comprehensive, structured, systematic, and cost effective individual and group curriculum that can be implemented, sustained, and spread in a practical and efficient manner.
What administrators say: “The WSM initiative is a terrific, engaging, and empowering intervention for mental health consumers. Giving staff a set of clear guidelines on how to involve consumers in the management of their own illnesses, this intervention helps our consumers take more responsibility for their recovery. Staff and clients love it!!” Amy Dorin, Senior Vice President, F.E.G.S., NYC.
“The timing of the wellness self-management program perfectly married with SUS’s organizational transformation efforts. For staff and consumers, it is the bridge between our values and ethics work and practical strategies to support individuals toward their recovery. The program’s success demonstrates the power of collaboration.” Donna Colonna, Executive Director, Services for the Underserved, NYC.
Frequently Asked Questions
Who provides WSM services? WSM can be provided by mental health staff and peer specialists who have received WSM training.
How long will WSM last? The length of time varies based on a number of factors including the treatment setting, the length of stay of people in the treatment program, individual or group modality, use of the entire or selected parts of the curriculum, and frequency and pace of meetings. In general, it takes about a year to complete the entire curriculum in groups that meet weekly for about an hour. Some programs may offer WSM more than once a week. It is important to remember that there is not a correct length for the program. Can family members or friends play a role in supporting a person involved in WSM? Yes. The person involved in the WSM program is offered an opportunity to identify friends or family members he/she might want involved. Family or friends may help by providing encouragement, discussing topics of interest with the consumer, providing assistance with reading the material, and completing action steps.
What principles guide WSM? Belief that recovery is possible; Emphasis on personal strengths and health; Emphasis on informed decision-making, self-determination, choice, and growth; Cultural respect; and Consistency with research-informed approaches
Are WSM Services Mandatory? No! Participation in WSM is voluntary.
Can a person end his or her involvement at any time? Yes! The decision to continue to participate in WSM is left up to the individual.
Has the WSM workbook been translated into other languages? The workbooks are currently available in English, Spanish, and Chinese. The Korean translation is currently in process and will be available by the end of 2008.
Can the WSM program be helpful to people from various cultures and religions? Yes. The WSM program respects each participant’s values and beliefs. It does not criticize or judge a person’s cultural or religious points of view. Rather, the WSM workbook provides participants with opportunities to better understand how their religious or cultural background affects their decisions about mental and physical health services. In this way, a person is in a better position to make informed health care decisions that work.
Does a participant need to read well to participate? No. If someone finds it difficult to read, he or she can attend, listen, and share ideas in the WSM group. People who have difficulty reading have successfully participated in WSM groups. This has been accomplished by the person: (1) Meeting with their group leader before the group to review the lesson; (2) Meeting with a family member or friend before or after the group to read or reread the lesson; and (3) Working with another member of the group who can help with the material. If working in a group program is not preferred, WSM can be provided in individual meetings.
Is the WSM program right for someone who didn’t like school or doing homework? Yes. Getting involved in the WSM program is a person’s choice. It’s not the same as school that insists on homework or gives a grade. Participants are given opportunities to continue their learning outside the group, but that decision is left to the individual.
Participants are not given a grade but, rather, invited to set some goals on aspects of their lives they would like to improve as they participate in the WSM program. WSM is something people freely choose because they have decided to explore opportunities to support their mental and physical health.
How does a person get a copy of the WSM workbook? Adults who have mental health concerns, family members, students involved in human service and mental health education, mental health professionals, administrators, and interested stakeholders in the mental health system in NYS may request a copy of the workbook through the Evidence Based Practices –Technical Assistance Center (EBP-TAC) at Columbia University. Electronic copies of the workbook are available at no cost. Depending on the number of requests, the Center may need to require a fee to cover basic copying and mail costs for bound hard copies of the workbook. Please contact Melissa Hinds-Martinez at hindsma@pi.cpmc.columbia.edu or call 212.543.5941 to request a copy.
How does a mental health agency or program interested in providing WSM programs get involved? As word had spread about the value of the WSM approach, additional agencies have expressed interest in the WSM program. In order to promote widespread implementation of WSM, OMH and the EBP-TAC at Columbia is developing a highly efficient and less intensive method to support agencies. This approach is referred to as a Performance Improvement Network (PIN).
Mental health programs in NYS have the opportunity to join a Practice Improvement Network (PIN). This network of providers is offered educational and training resources to support agencies in providing high quality WSM programs. We request that agencies that are considering providing WSM programs do so as part of a PIN. We also request that agencies NOT make copies of the workbook and implement the program without collaborating with the Center. Please use this link to learn more about how to join a Practice Improvement Network: www.nyebpcenter.org
In a PIN, resources are designed to enable agencies to successfully implement WSM programs without the expense and effort associated with numerous face to face strategy meetings and training sessions with supervisors and staff.
Agencies interested in joining a PIN are provided the following resources and tools: (1) Written materials including the WSM workbooks in both hard copy and electronic versions, group leaders quick guide, performance indicators guidebook and informational brochures; (2) Informational web site for WSM group members, group facilitators and other mental health providers; (3) Monthly phone consultations; (4) Training and promotional materials in DVD and VHS formats; (5) Web based data entry and analysis; (6) Web based 3 hour course for staff and supervisors on how to conduct a WSM group program.
The EBP-TAC at Columbia is currently accepting applications from agencies interested in joining a PIN. To find out more information about the PIN, please visit the following website: www.nyebpcenter.org . You may also contact Melissa Hinds-Martinez at hindsma@pi.cpmc.columbia.edu or call (212) 543-5941 for additional information.
The NYSOMH and the EBP-TAC at Columbia look forward to partnering with interested agencies to implement WSM programs.
