For those of you who have not purchased the Intentional Care Performance Standards and who are not members of our on-line learning community, below is a sample of the new, 20 page standard. We think these standards help to build recovery-oriented competencies in the mental health workforce. Feel free to share this sample of the new standard with others and we hope you will join our on-line learning community soon!

SAMPLE FROM NEW PERFORMANCE STANDARD:

Performance Standard 6

Hope is central to the recovery process. Words and phrases that communicate hopelessness and chronicity can be truly hurtful to clients as conveyed in this story told by a former client in the mental health system:

"Sheila had been in (the hospital) for a long time in real bad shape. But one day I noticed something changing in her. She seemed hopeful or something. She seemed happy. And it lasted awhile and finally I asked her and she said she had talked to her social worker and there were a bunch of government jobs available. She had some shorthand and typing skills. Her plan was to get one of those government jobs. And she was really starting to get better cause she had a reason to hope...But one day she was talking to two attendants and telling them about her big idea (of getting a government typing job). And one of the attendants says, 'You've got to be kidding. Do you really think you're gonna get that job? You'll never get that government job because you've been in here. This is a state hospital! After that it was like she just slid down a razor blade they had set her on. It was a shot right to her heart. It took a couple of months but soon she no longer wore shoes, she no longer took a bath, she no longer washed her hair or brushed her teeth. She barely spoke to people. She was still like that, even after I left."

Although we would hope that such demoralizing and hurtful statements would not occur in this agency, our survey results indicate otherwise. Examples of the types of demoralizing words and statements witnessed by staff and clients include:

• She is never going to change
• He/she is chronic
• You're a substance abuser and that's all you'll ever be
• Loser
• You'll never get better
• You're doing well for a schizophrenic
• You can forget about getting a job

Sometimes staff feel they are being kind when, in fact, they are giving a demoralizing message to a client. Examples include:

• Telling a client they are doing well for someone with a particular diagnosis i.e., "For a schizophrenic, you are doing very well."
• Telling a client to lower his/her expectations i.e., "You are not that high functioning. You should try a volunteer job."
• Presenting a client with a double standard i.e., "The medications help you be less psychotic so you'll just have to learn to live with the medication side-effect of sexual dysfunction (even though I would never expect myself to live with that impairment)."
• Pretending to be able to predict a client's future i.e., "You should make things easier on yourself and just accept that you can never get your kids back"; "Why put yourself through the stress! People with your illness can never get a drivers license and it's best for you to learn to use public transportation"; "It's important for you to remember that you'll have to stay on medications for the rest of your life."

Demoralizing messages are never kind. In truth such messages say more about a staff person's crisis of hope, than about clients' capacity to progress and recover. Staff crises of hopelessness should not be projected onto clients.

In order to build a more hopeful culture in Advocates Inc. programs, staff will become more sensitive to messages and ideas that serve to demoralize clients, will attend trainings that engender hope, and will refrain from making demoralizing statements to clients.

How to implement this standard

1. Staff will learn to distinguish between their own crises of hope, and the potential of clients to progress and recover. If noticed, supervisors will address staff hopelessness during supervision.

2. Supervisors will encourage staff to attend conferences and read materials about recovery. Information about recovery and other hope engendering information will be presented during staff trainings and orientation. Materials such as videotapes, audiotapes and papers about recovery will also be available through the program.

3. Supervisors will encourage staff to become sensitized to messages and ideas that convey hopelessness. One possible way to do this is to assign, on a rotating basis, one staff person to be a designated listener during clinical meetings, intake meetings and/or staff meetings. When a demoralizing idea that reflects a staff person's crisis of hope has been communicated, the designated listener should ring a bell and bring the groups' attention to the situation.