It Takes a Community: Learning Together about Tools and Strategies to Support People through Emotional Distress

Moderator: Jane Tobler
May 29, 20144
2:00 pm CT

Coordinator: Welcome and thank you for standing by. At this time all participants are on a listen-only mode until the question-and-answer session of today’s conference. At that time to ask a question, press star one on your touchtone phone and record your name at the prompt. This call is being recorded. If you have any objections you may disconnect at this time. I would now like to turn the call over to Jane Tobler. Ma’am, you may begin.

Jane Tobler: Thank you. Hello and welcome to It Takes a Community: Learning Together about Tools and Strategies to Support People through Emotional Distress. Today’s Webinar is sponsored by the Substance Abuse and Mental Health Services Administration’s Resource Center to Promote Acceptance, Dignity and Social Inclusion Associated with Mental Health, also known as the ADS Center.

SAMHSA is the lead Federal agency on mental health and substance abuse, and is located in the U.S. Department of Health and Human Services. Please join the ADS Center listserv to learn more about social inclusion, including upcoming Webinars, new resources, and events. As the operator said, this Webinar will be recorded. The presentation video archive including closed-captioning and a written transcript will be posted to SAMHSA’s ADS Center Web site at promoteacceptance.samhsa.gov in late June.

If you would like to download a copy of today’s presentation, you can do so immediately by going to the training teleconferences center of the Promote Acceptance Web site. The views expressed in this training do not necessarily represent the views, policies, and positions of the Center for Mental Health Services, the Substance Abuse and Mental Health Services Administration, or the U.S. Department of Health and Human Services.

Our presentation today will take place during the first hour and will be followed by a 30-minute question-and-answer discussion. At that time you may ask any questions that you have of our presenters. And now on to our teleconference topic.

In today’s busy, stressful world, the need for supportive community is more important than ever. We all struggle at times, whether due to sadness, anxiety, other mental health challenges, or simply the stresses and challenges of everyday life.

When we are having difficulty, the support of others can make a significant and meaningful difference to the quality of our lives. Knowing that we are part of a community, that we belong and have meaningful relationships with others, is an essential part of living fully. These connections with people in the community can help us see through difficult times, provide an outlet to share our joys, and provide the opportunity not only to receive but to give of ourselves.

But for some of us, establishing these connections with others is more difficult, and left unaddressed, this can lead to isolation and feelings of abandonment, which may contribute to emotional distress and emotional crisis. With the increased frequency of tragic shootings such as Sandy Hook Elementary School, the Washington Navy Yard, and others that remain embedded in our memory, many members of the community understandably feel vulnerable, fearful, and even powerless to effect positive change in their community.

We must remember that there are many ways that we as individual community members can and do provide common sense support and assistance to individuals that can help prevent these tragedies. Everyone can make a difference. Even the simplest act of humanity may have ripple effects on the community. These tragedies are preventable, but it takes the entire community working collaboratively to make that happen most effectively.

When people feel that they have a meaningful and valued role in the community, they are less likely to act out, to hurt themselves or others. We need to develop a safety net so that we can connect with people before they reach the boiling-over point of desperation. Having a thoughtful, compassionate, and safe person to turn to for guidance can prevent distress from escalating into tragedies. At the ADS Center we are humbled yet delighted to join with you and our presenters today to look at how we can build safer and more inclusive communities and prevent these tragedies.

During today’s Webinar, the first of a two-part series focused on mental health promotion and early intervention, we will share with our listeners information about tools and resources that anyone can use at any time to support someone through an emotional crisis, or to prevent an escalation to an emotional crisis so that individuals experiencing distress no longer need to struggle in isolation.

We will hear from our three presenters about practices that can be used in communities, in families, and on university campuses to support individuals who are experiencing emotional distress, and how using these practices to offer support can help prevent escalation to emotional crisis. We want you to leave this Webinar with ideas and renewed hope for how each of you can contribute to building the type of communities that we can be proud of, communities that support people before they act out in desperation, communities where everyone is included and respected, and everyone makes a positive impact.

Our first presenter is Leah Harris, the Director of the National Coalition for Mental Health Recovery. Leah has written and spoken widely about her own experiences of trauma and healing, and as a family member of people diagnosed with mental health issues. Leah is an Emotional CPR facilitator as well as a consultant on trauma-informed practices for the National Center for Trauma-Informed Care and on new innovations in suicide prevention with the Center for Dignity, Recovery, and Empowerment, a project of the Mental Health Association of San Francisco.

Today Leah will provide us with an introduction to Emotional CPR, a primary prevention and public health education effort that trains people to assist anyone through severe emotional distress, trauma, and/or disasters. Thank you for joining us, Leah.

Leah Harris: Thank you so much. It’s a pleasure to be here. Let’s go to the first slide where we talk about Emotional CPR, what is it? So we look at Emotional CPR as a way—it’s sort of analogous to regular CPR where all community members learn how to assist someone who’s having a cardiac crisis, and so we look at Emotional CPR as about helping to resuscitate someone’s emotional heart, you know, where their distress and sadness lies.

It is a public health education and health promotion program and the idea again as was said earlier is that this is to prepare the entire community to assist someone who’s experiencing distress or crisis so that people know what to do, know what to say, feel confident, feel equipped, because any one of us at any time, no matter who we are or where we are, have the potential to interact with someone who may be in different levels of distress or crisis.

So this training about eCPR is often 2 days long, so this is going to be obviously very abbreviated, but I encourage you to visit our Web site to learn more, which is listed in the resources on these slides. And I’m going to focus on the C, because I feel that’s the most important perhaps—that is at the heart of Emotional CPR, is Connecting. And in our experience, a lot of distress is driven by disconnection, where a person is trapped in a monologue in their head.

And through Emotional CPR we move out of the monologue and we move into a place of dialogue where new insights and new learning can happen. So that’s what gets to the P, which is emPowering. That is really so that a person is able to access their own inner wisdom to find the solutions to the distress and crisis that they face, and they do that in the context of support, a supportive community.

And then the idea is that through this process, this person who has been disconnected and isolated is now finding a way to reintegrate into their community, to find valuable goals and to feel reconnected with their community, so this is really about supporting people to move from disconnection and isolation to feeling connected to others, themselves, and their community. Next slide, please.

So I’m going to talk a little bit about the foundations of eCPR, just go through these very quickly. This training was developed exclusively by people with lived experience of all different kinds of mental health issues, crisis, feelings of suicide, addictions, so we really have created this training out of what we wish had been available when we were going through our own crises, and so using our lived experience as to what helps and what might not be so helpful.

It is also based on the different components of recovery that have been defined by SAMHSA and many others, things that it’s person-centered, holistic, individualized, you know the idea that a path of recovery or healing from crisis is nonlinear, so these different kinds of components that you can learn more about, and also crisis counseling following disasters and sort of helping people to heal from these kinds of terrible events. Next slide, please.

So really, really crucial foundation of eCPR is what is known as trauma- informed care, or trauma-informed approaches, and this is a big subject, but the basic idea is that most if not almost all people who are in mental health systems, if it’s substance abuse support, in the criminal justice system, who are experiencing homelessness, trauma is an experience that has impacted them in some way. We make that assumption.

We don’t know what it is, but we assume that this person has experienced a form of trauma in their lives. So we don’t ask the question, you know, what’s wrong with you. We really proceed more from the question what has happened to you, and that’s—that informs the way we interact with another person. It’s also based on suicide prevention principles, and the cultural piece is extremely important, and we’ll talk a little bit more about that later.

But really an understanding of how culture influences the way people respond to distress and crisis in their lives, and meeting people where they are, which I will talk about as well. Next slide, please. So I wanted to go through and just touch on some of the points in this chart but—so it kind of helps to compare conventional approaches to supporting people versus approaches of eCPR that are very informed and the whole idea of peer-to-peer support.

But this, you know, again, these approaches can be used by anyone in the community. So the first one I’m going to talk about is the idea of sharing our emotions and our own experiences. You know, people go into social work, all fields of mental health because they truly care, as do almost all community members. They truly care, they want to make a difference, and a lot of the times the way that conventional medical training or mental health training has happened is that people are taught to maintain objectivity.

You know, do not show your own emotions, don’t share—if you have a relevant experience, you know, don’t share that, and I know that that’s not the case across the board, but this is a sort of traditional way that people are trained in mental health. And the Emotional CPR approach says that you know, we are building mutual relationships with another person, that relationships are actually what heal us, respectful, you know, mutual relationships.

So in an authentic relationship, it makes sense to express your own emotions. Obviously you want to focus on the person and not make it all about you, but it is okay to say, oh, this is feeling you know, scary or I feel sad hearing that. It’s okay to say that, and that’s part of being an authentic person, as well as if you have an experience that’s relevant. I talk about this often in the context of suicide prevention, that someone might get—it’s very common to have suicidal thoughts. A lot of people have suicidal thoughts.

And so if someone is expressing to you that they themselves have felt suicidal, it can be so healing as someone myself who has been suicidal, to hear the words, I understand, I felt that way too. Let’s figure this out together. That’s a very different experience as to you know, someone who’s just sort of listening but not sort of sharing anything from their own experience. And then the issue of power. Power dynamics are in every relationship and that is often not acknowledged in the traditional clinical situation, but it’s an elephant in the room that we need to acknowledge. You know, so we’ve been studying this idea that you know, you are the “sick” person and I am the “well” person if you will, you know, sort of “fix you” in a way so to speak. The idea is that you know, we’re in this together. You know, we are mutually trying to figure this out together and it’s a very sort of different dynamic when you’re with someone as to you know, power over someone.

Next slide, please. And then I wanted to talk about the issue of belief. This is huge, because what we believe about another person colors everything we say and do. So if we believe that the person is broken, sick, and not able to help themselves we’re going to proceed from that belief and it’s not the most empowering sort of approach for the person receiving support. But when we believe that this is a whole human being, no matter what they have gone through, no matter what horrible experiences they’ve been through, no matter what diagnosis they may have, they can heal, they can recover.

And again, this is in the context of a supportive relationship, and a supportive community. That is a very healing thing. And then as far as you know, training, certainly we see that everybody in the community, you don’t have to have a special therapeutic training. Certainly this would also be helpful for people who do have therapeutic training as an adjunct to their existing training, but just the idea that really any human being who cares, who wants to make a difference, who wants to support their fellow community members, all you need to bring is your heart.

And so that is really what we believe. Again, in terms of language, we try to stay away from referring to people in clinical terms. I understand those terms, you know, have their place, but with the eCPR approach, we don’t try to label people’s experiences. We don’t tend to talk in clinical terms. We talk about sadness. We talk about anger. We talk about fear, without sort of pathologizing these things.

And also we want to be aware of you know, people’s culture again and how that influences the way that they respond to distress, and that is hugely important, and not to make cultural assumptions like if this person is from a certain culture then they would automatically find this helpful. You know, we don’t make assumptions about people’s culture. Next slide, please.

So what we like to think are the implications of this approach is that it really fosters hope, and when someone is in a crisis, more often than not, they are without hope. They are completely hopeless, and so we really try to help people to understand that no matter what, again, no matter what you’ve been through, you can heal, you can get your life back. You know, we’re in this together. It promotes self-determination, which is a principle that is very, very important, particularly among the cross-disability community.

But as well as if you look at everyone from you know, small children to our elders, self-determination is very important to all human beings, so we really try to promote that and to always maintain people’s dignity. And again, you know, putting people at the center of their own decisions, whether it’s their treatment or other decisions about their lives, we can, you know, trust that they, you know, can be involved and should be involved in those decisions very centrally.

And I think perhaps the most important thing is the creation of nonjudgmental and safe spaces for people to express the stress. We don’t have enough of those. As we all know there are enormous gaps in community-based services and support. In almost every community, people don’t where to go. They don’t know what to do. You know, there’s a really, really sort of broken crisis services system that we have here.

So it is really up to all of us to create in however we can nonjudgmental and safe spaces for people to express their distress so that they don’t hold it inside and hold it inside and hold it inside until a crisis has happened. Next slide, please. So the applications of eCPR, basically as I said, it really can be for anyone at any stage, very much we see this as a way to prevent crisis. You know, so someone might start out just being distressed about a situation.

And you can use the eCPR skills with them. You know, someone may be all the way to suicide or experiencing psychosis, and we say that you know, no matter what someone’s state of mind is, even if they’re not in the same consensus reality, we can still reach that person, and we feel that people who’ve experienced psychosis themselves and have recovered are some of the best people to reach out to and support the dignity of people who are going through that experience currently.

And again, it can be used by anyone in the community, from first responders to friends, coworkers, and community members. Next slide, please. So I’m going to go through really quickly, and I apologize, I can’t get into this in detail but just some of the basics of eCPR in practice. First of all, to always be humble and curious and avoid making assumptions about a person’s behavior. We don’t make a negative judgment.

We ask open-ended questions. What was that like for you? You know, and that’s really huge, you know, just to not try to make assumptions about a person’s experience, and again, to believe in people’s resilience and ability to heal, which is what gives people hope to go on. Next slide, please. Some more basics, just validating the person’s experience, you know.

I think so often we try to sort of label a person’s experience, but just to validate it, and to say that’s frightening, that’s terrifying, I would be—I would feel the same way you would. It means so much when people have their experience validated. And listening, we could do a whole Webinar on listening, but the idea is really to listen wholeheartedly rather than sort of half-thinking about what you’re going to say next, to really practice being there, being present and listening.

And then, really looking at someone’s body language and tone and being aware of that and trying as much as you can to match that tone, not in a sort of mimicking way, but just in a—being aware of the nonverbal, the importance of the physical behavior and the nonverbal cues that someone is sending. Next slide, please. How I use it in my life: wherever and whenever I can, and from everyone from my 8-year-old son to just people I meet on the street, colleagues, friends, and family members.

Really we say that these are practices that you can use in your life at all times, listening, you know, not trying to fix another person, but helping them to discover their own solutions. That works with my 8-year-old, works with my 40-something friends. It’s very effective and powerful. Next slide, please. So oh, sorry, just go back one more. So yes, just quickly, I know I’m almost out of time. I just wanted to share very quickly just a few stories from my own life about how I have both used eCPR and been—received eCPR.

One story was with a young man who I met when I was speaking at a college, and he was starting to go into crisis and was very afraid, and he reached out to me. He was too afraid to reach out to the campus mental health review, was very isolated. He didn’t know what to do, and I used these practices with him, meeting him where he was at, trying to find out, you know, his needs, you know, validating his experience.

He had experiences that some people would call paranoid, and instead of you know, trying to talk him out of his paranoia, I just felt into what that felt like and validated his experience and found out what his needs were. He had some, you know, physical needs that weren’t being met, and I helped him to meet those needs, and basically through that experience he ended up not having to you know, withdraw from the university and was able to get connected with other resources and support and the crisis did not have to take you know, a terrible turn.

And then in my own life I was going through a terrible, painful divorce. I had a very young child, and I found someone, a friend, I reached out to them and they came and they helped me. I was very afraid of being hospitalized and separated from my child, and through you know, my friend using these practices with me again, meeting me where I’m at, finding out what my needs are, helping me to meet those immediate needs to kind of deal with the crisis.

She helped me to get child care so I could get rest and you know, she helped me with a lot of other immediate concerns that I was facing. And again, positive outcome—I did not have to go into the hospital. I did not spiral into crisis. I was able to you know, stay with my friend, be a parent, you know, be a worker, be a friend, you know, all the things that I wanted to do. So I just want to say that you know, this really has a powerful, powerful impact.

It has in my life. I’ve seen it in other people’s lives, and I’m really, really thankful to have these practices in my own life, and I encourage everyone on this call to check out other trainings in their area. Next slide. So here is information as to how you can schedule a training in your own area. Please again, explore our Web site to learn more, and thank you so much for listening.

Jane Tobler: Thank you, Leah. That was very good information. Right now we’re showing you some of the resources as well as how to contact Leah. And so those are up there on slide 18 and 19. I think this information is very simple, and the tool is very hopeful, very useful, and it was really good to hear how it works and the ways it can be used to support anyone experiencing emotional distress. So we really appreciate you doing that with us today, Leah.

Our next presenter is Lisbeth Riis Cooper. Lisbeth is the Founder, Vice Chair, and visionary behind CooperRiis Healing Community. Lisbeth saw a need to establish a new kind of mental health organization, a therapeutic community where individuals could truly recover and go on to lead meaningful lives, battling 10 years of navigating a fragmented mental healthcare system, trying to help a close family member who struggled with mental illness.

A few years ago, Lisbeth saw a need for a new kind of learning for families that go beyond just educating about symptoms and medication. With this resolve Lisbeth became a Founding Partner of Families Healing Together. Today, Lisbeth will discuss recovery education and support for families and how these can help individuals and families to cope with distress and promote mutual support and family healing. Thanks for joining us today, Lisbeth.

Lisbeth Riis Cooper: Thank you so much for that wonderful introduction. So I’d like to start out with sharing I’m just a mother. I have no mental health background or training, never wanted to be in mental health, but life kind of took me there when my youngest daughter experienced mental health challenges the year she was going to college. I kind of didn’t have a clue what to do or what was going to happen next. And we spent the next 10 years in what I call mismanaged care, in and out of hospitals, in and out of group homes.

She did not want to stay in any of them and frankly I wouldn’t have stayed either, because it was always about the diagnosis. It was always about the hopelessness, and the first time she was hospitalized she gained 40 pounds in 3 months, and I decided that this can’t be good. This can’t be happening in my family. It simply could not be. I felt I was absolutely hopeless. I was absolutely helpless, and the anger and the shame.

I could not even tell my close friends what was happening, and everybody were talking behind my back because they knew something was happening, and I remember the first time I was able to share with a friend what was happening in my life and I felt such a relief. I finally let it out. I wasn’t alone anymore. I also realized that the last time we had an episode, which was in 1999, there had to be a better way because there was simply no way that I could deal with this anymore.

And I could only imagine what other families were coping with. So I went home and I asked my husband if he would help me to—help me build this therapeutic community, and I’m trying to get to the next slide. Could somebody get the next slide for me? Oh, here we go, thank you. Asked him to help build this therapeutic community, and he thought that I probably had lost my mind now, but because he said we know absolutely nothing about mental health.

My husband is an actuary, and I came out of the apparel industry in New York City and then doing interior design for many, many years as well, and I said, “Well that’s what makes us perfect for this,” and he looked at me like you’ve got to be out of your mind. I said, no, because in over 10 years I have seen what didn’t work. We do the opposite.

When they focus on diagnosis, we’re going to focus on possibilities. When the mental health professional focused on there’s no hope, I say we’re going to do the opposite, and we’re going to do something really dramatic. We’re going to have organic real food, we’re going to have exercise, things that’s been important to me. We’re going to give people purpose. They’re going to have work to do, but it’s not going to be made-up work, it’s going to be real work.

And we don’t focus on the diagnosis. Instead we’re going to ask, what’s your dream? How can we help you achieve your dream, to become what it is you want to be? We want people to have—people have been quote unquote diagnosed with a mental health challenge, they want the same thing in life as we do. They want to have a family. They want to have a home. They want to have a job. They want to have a purpose. They want to have friends. It’s really pretty basic, and I said that’s what we’re going to do in our mental health facility.

And we’re going to focus on recovery education and we’re going to help families along also because if we don’t educate the families along the way, we have lost everything. Next slide, please. So we—the power of healing community is evident every single day. People—I see young people come in, older people, people of all ages and feel they’re accepted. Somebody comes to our facility with a very high level of anxiety.

They sit down for lunch and somebody asks them if they want to play basketball later, and you can tell they are looking at you like you’re out of your mind. Why would I want to play basketball? I’m here because somebody diagnosed me with a mental illness. I even say I don’t like to use that word. I’ll use it here. And how can I play basketball? But after a few days or a few weeks they realize that they can be as normal as any of us and have a life.

And it starts with when someone believes in you when you don’t believe in yourself. That is probably the most powerful thing. If I don’t believe in myself, how can anyone else? But if you believe in me, maybe then I can start believing it also. And I see how our actions, just the small things make a difference in somebody’s life. We also meet people where they are, and I heard Leah speak to that as well.

It’s not about your diagnosis. It’s about the person you are, and what your strengths are. I remember a young man saying I can’t play tennis anymore because somebody tells me I have schizophrenia, but it didn’t take long before he realized that he could play tennis just like he could before. So meeting people where they are and change happens, one person at a time.

Next slide please. But we also soon realized that families needed a healing community as well, because if you don’t educate the families, then you’re failing the individual. Sometimes when I hear families, the language they use speaking to their loved one, and we try then and help the families by giving them language that’s therapeutic, language that’s—people can respond to. We don’t speak about somebody—Sam having—Sam is not schizophrenic.

Sam may be having schizophrenic challenges. He doesn’t have a mental illness. Well, he may have a mental health challenge. Sam has—we don’t say Sam has been diagnosed with something, or—no, I mean, we say Sam may have been diagnosed with some bipolar disorder. We don’t say Sam is anorexic or Sam is bipolar. So the power of language is also, and that’s one part of what we will teach families. Next slide, please.

When I saw this study, this actually came out of SAMHSA and it was published by the University of Kansas Mental Health, that families not only are the main support, but—I’m on the wrong slide, I’m sorry. Families are the main support. When I have listened to families over the last 11 years, 80 percent of them get absolutely no support for themselves. How can you support your family member if you don’t have that support and education?

And that awareness led to developing a class that’s called Families Healing Together. It’s a recovery education, and it is done online in a virtual community to make it available to as many people as possible. Every class starts on the 15th of the month, and this is our third year of doing it, and it’s absolutely amazing to see people who respond to each other in a virtual community, because that’s another thing I learned, that some people don’t want to—they want to be in private—they want to preserve their privacy of themselves and their families. Online you can have that opportunity. Next slide please.

So what is Families Healing Together? Well first of all we wanted to be a very safe and nonjudgmental community where feelings can be shared and be shared openly and honestly, it’s also a place where we validate each other’s emotions, and we all have certain expectations for our family member or be it being a spouse, a son, a daughter, is going to go on to college, going to go on to have a great life, and somehow a mental health challenge just kind of cuts into that.

So this is also a place where we can openly share all of those feelings. This is where—and validate them. I have learned that validating a person’s emotions is probably one of the most important things that you could do, whether there’s a mental health challenge involved or not. It’s a community. We’ll go back to the community. We had a professor who stayed at CooperRiis for 6 months and interviewed students and then interviewed not our students but our residents and our staff.

And the one thing he came up with from everyone, the most important aspect of healing is being in community, being accepted, and that way you are being loved for who you are and not for what other people expect from you. And it’s also going back to Families Healing Together, it’s a virtual community where people can share their experiences of what they have experienced. And it’s an opportunity to learn from others and practice new skills.

Next slide, please. Most importantly is that you are no longer alone when you’re in community, and I think that’s important. I was alone for so many years when my family member didn’t know where to go, didn’t know where to do, didn’t know what to say. All of my friends kind of disappeared because I was not fun anymore. And I couldn’t—all of my monies were being spent helping my family member, so therefore I could not socialize either.

And I think this is probably one of the things I hoped to get across to other family members today: You do not need to be alone. There is help out there, and learn to build trust with your family member for starters, and that is meeting them where they are and learn recovery language and speak to them in a way that empowers them instead of starting to diagnose the person or say what’s wrong with you, instead of saying I can really tell you are having a difficult time today. How can I support you?

And I can just see in my own family member how the distress level just goes all the way from 100 down to maybe 50, but that’s better, and then we just go on. Once in a while she will say something, are you doing this recovery stuff again, and I will say yes, because it’s working, and then we start laughing and then we keep on going from there. So—and another thing I also had to learn is that you can only recover for yourself.

You can’t recover for your family member. That was important for me. I wanted to be the fixer. I wanted to tell her how to take charge of her life. I wanted to fix the problem. But you can’t fix anyone else. You can even hardly fix yourself. And if I can just take—if you can just take that one message home with you today, take care of yourself first. Put on your oxygen mask first, and then you can help your family member. Next slide, please.

This is where I realize just how important it is, and again because I have started—I was ahead of myself before, but this is exactly out of SAMHSA, but it was published by the University of Kansas, School of Social Welfare, that family—that a relapse can be reduced to up to 75 percent, 75 percent if the family has mental health education. And when I speak about that, I mean recovery education. It’s huge.

Imagine this, you know, we always, and I did it myself, we always look to the professionals for all the answers, but the answers lay within—it lays within every parent, every spouse. You have the power to make the change. You have the power to create that change. You have the power to say yes. You have the power to say no. You have the power to validate. You have the power to take charge of the situation. You have the power to set boundaries.

One of the things I learned with my daughter after 10 years was I had to set boundaries, and that when you set a boundary, you also have to learn that the expectations may not be what you wanted them to be. I had to accept that, and it worked. She started getting better. So it’s absolutely the most empowering thing. She went back to school after that. It was not a pretty situation for a long time, and it was very difficult for me, but I set my boundaries very clear and very concise, let her know exactly what I was willing to do and not willing to do.

And once in a while we have to go back there, but I was emotionally honest, and I was honest with her and I was honest with myself. I set my limits on communications, and I learned that she could get better that way. So it allowed her and it allowed me to grow and learn from personal—from our own experiences. I became an ally rather than an adversary. Next slide, please.

The recovery path is not linear, and don’t expect it to be pretty all the time. It will have its ups and it will have its downs. Next slide please, so last but not least, recovery is a journey from seeing oneself as a diagnosis to a positive personal identity, hopelessness to hope, alienation to meaning and purpose, and withdrawal and isolation to participation in meaningful activities, and we’re out of time here I think, so next slide please.

And so we’re going to skip this one because we are out of time, so here are some resources that will be available on the SAMHSA Web site, and last but not least my email, how to contact me, the Web site, and I thank you for your time today. Hope is present.

Jane Tobler: Hope is present. Thank you, Lisbeth, for sharing that. And in front of you on slide 34, you can see the information on how to contact Lisbeth, and it’s got her email as well as the Web site for the CooperRiis organization and the Families Healing Together as well. So I really appreciated hearing about Families Healing Together and how that is helping families build a supportive community where they can learn and practice new skills that can make a huge difference on their own lives and the lives of their loved ones. We really appreciate that.

Our final presenter today is Dr. Tom Murray. Dr. Murray is the Director of Counseling and Testing Services at the University of North Carolina School of the Arts, and a licensed marriage and family therapist and licensed professional counselor. Dr. Murray serves on faculty within Walden University School of Counseling and within Wake Forest University’s Department of Psychiatry and Behavioral Medicine as a voluntary clinical assistant professor.

Additionally he serves on the editorial board of the Journal of Mental Health Counseling, published by the American Mental Health Counselors’ Association. Dr. Murray is a certified trainer and facilitator of the Partners in Change Outcome Management Systems, and Emotional CPR. Both approaches aim at elevating and privileging the voices of those in distress.

Today Dr. Murray will talk about the new practices that he has introduced on campus that encourage and equip both teachers and students to support members of their community experiencing mental health challenges and how these are making differences on the campus ministry—sorry, campus community. Thanks for joining us, Dr. Murray. Tom.

Dr. Tom Murray: Thank you for having me. It’s an honor to be on this panel with Leah and Lisbeth and to have so many listeners and viewers for this presentation today. During this presentation, I’m going to showcase a number of services that we’re offering at the University of North Carolina School of the Arts, UNCSA. I’ll start off by giving a general overview of the trends within higher education, and then go into detail as we go on with the presentation.

More recently, particularly within the last 14 years, with a number of violent incidences occurring on campuses, campuses responded to meet the needs I think of mental health—of students with mental health concerns with a very targeted focus. One of the greater developments has been this cross-departmental Threat Assessment Team that many campuses have, and often these teams will convene if a student has been identified as someone who potentially poses a threat to campus.

And these teams often include members of various offices such as residence life, judicial affairs, perhaps the campus attorney or campus police including counseling center directors as well. Again, the pressure, there’s such pressure on college campuses to identify these students and to access resources for them. As a consequence some campuses will view hospitalization as the first line of defense rather than the last resort.

And that’s really a shift away from the developmental model of college counseling in which our emphasis historically is to view student symptoms within the context of a developmental perspective, that they may be stuck at some stage of their development, and how do we facilitate their growth through this and make it an educational experience for them.

As a consequence though, hospitalization can be very stigmatizing for students, for anybody in general, and there’s an unrecognized effect of hospitalization, and that is that there tends to be a spike in suicidal attempts within that immediate period after discharge, so even the thing that we are trying to prevent, we—by the very tactics that we use, we may actually increase the likelihood of that event for some people who are vulnerable.

Now to review, a lot of these—this movement is a fear-based mentality about students and particularly students with emotional crises. In other words, this is viewed as students must be dangerous if they have emotional symptoms. I remember someone wanting to know any time that students had suicidal thoughts, you know, they wanted us to inform upper administration, and I had to reiterate that suicidal thoughts are quite common and that it has no bearing—it’s not a linear connection between just having suicidal thoughts and dangerousness.

And this is all a movement towards a greater adoption of the disease model of mental illness, and as you’ll—many of the listeners here will recognize that the disease model simply says that there is something wrong organically with the brain, and the research that has looked at the question of the explanatory style, that is, do I view mental illness as a disease or do I view emotional crises as some kind of developmental stuck period that the holding onto the view that it is a disease process.

Well if somebody has a diseased brain, then it’s logical that they would be dangerous and unpredictable. Unfortunately, when we hold that model and explain mental illness or psychiatric distress within the disease model, it actually increases stigma and distance, social distancing. So—which then, you know, with greater alienation, may lead to a more paternalistic approach by campuses in order to avoid risk.

Now on our campus we’ve moved to really emphasize that, on—within the counseling center in particular, how do we honor students’ voices or clients’ voices? How do we elevate them in terms of the services that they provide? I’ll talk a little bit more in a second about the client-directed outcome- informed, and I’ll go into more detail on that. But I wanted to reiterate that the real shift was inviting their voice as the student’s voice in the overall operations of the counseling center and more particularly within the services that they’re provided.

You know, are they—their perspectives being held to even a higher regard than perhaps our theories about what makes change happen? You know, if I can hone into what their theory of change is and provide support and services around their theory of change, I’m more likely to be much more influential in their health and healing. And of course that involves the adoption of peer- related services, eCPR, which I’ll mention again a little bit more.

And then overall, seeing hospitalization as the last resort, and resisting and educating the campus community when there is that impulse to remove students from campus as soon as possible if they have or are demonstrating any psychiatric symptoms—and as an alternative providing them with peer-based support and other support services.

So one of the great initiatives that we’ve done is—and I’ll review just broadly, eCPR, acknowledging faculty and staff who support students, using students’ response to the strategies we’ve been employing and as a jumping-off point and then implementing the Partners in Change Outcome Management Systems. Now with eCPR, in 2013, 20 faculty including deans of our university were involved in the inaugural eCPR training.

And the response was absolutely overwhelming. Of course eCPR training occurs over a 2-day period. They get to have a lot of experiential activities that lead to the participants really getting to know each other on a personal level, not just on a kind of a superficial work-related level. Then following that, and just a few months ago back in January, we had six students, all of whom were clients at one time or another of the counseling center within the eCPR, getting the eCPR training.

And those students were so enthusiastic about their experience that they had decided to move towards being formally recognized as a campus organization and of course that opened up opportunities for them to get funding from the campus for programming and then as well as I serving as their advisor. Essentially what my goal for the participants of eCPR is to help them—and this is true of all eCPR training—is to help them get more comfortable with the anxiety that they feel, that begins to bubble up within them in the face of others’ distress.

Now often when we are distressed by others’ emotionality, we want to fix it and we want to give advice, and we want to take on this kind of expert rescuer role, rather than noticing the distress bubbling up and in a sense doing eCPR on ourselves so that there’s the spaciousness there for the distressed person to access their own inner resources and find solutions that work within the scope of their lives versus taking on this perception that I know what will work for you independent of whatever resources are accessible to you.

So, helping people to manage their own anxiety as well as helping people feel more comfortable approaching those in distress, I believe it’s about 75 percent of people who are—the statistic I’m kind of fuzzy on, but most people who make it through a period of high suicidal consideration, they get through that hump because somebody reached out to them, and somebody was kind of a fellow traveler with them. And I think eCPR provides that sense of competence that I can do this, I can be with someone in the space of their pain and support them to the extent possible and then get them plugged into other resources that may be available to them.

So eCPR has been very effective so far. Even directors who supervise some of the participants of the eCPR that—particularly with that inaugural group have told me and totally that their staff continued to use it and use it positively. I had mentioned one of the ways of recognizing faculty and staff on our campus, I had begun a Mental Health Hero Award in which students are encouraged to nominate a faculty or staff member who has been instrumental in supporting their emotional health.

And incidentally the person who received the award this year was one of our eCPR trainees and we’re very proud that she received the award. So you know, the reality is that about 90—80 to 90 percent of students on campuses who complete suicides, most of them do not show up in the counseling center, and eCPR is just one way of getting them—having the community be available to assist one another in emotional crises, because their eyes are going to see things way before my or my staff’s eyes see a concern.

I also wanted to briefly talk about the Partners in Change Outcome Management System. This is a system that we used in the Counseling Center since 2006, and it really is designed to instrument procedure that takes about 30 seconds, each instrument takes about 30 seconds. One is in the beginning, and one at the end of each session. And essentially it’s to monitor whether the services that we’re providing is effective.

And it monitors the therapeutic alliance, and we know that the therapeutic alliance is a much more powerful predictor of outcome than any particular therapy that is provided. In fact, the actual type of therapy that’s provided contributes to less than 1 percent of the total variance of change, so it’s very minimal. Using PCOMS often improves the clinical effectiveness of the therapists up to 67 percent, so there’s a greater effectiveness of overall services, which then is a much better utilization of resources.

Session limits, there’s no need to have session limits because most sessions are—most people will achieve the greatest amount of gains within the first four to six sessions, and what’s nice is that therapists don’t have to learn any new theory or technique. It’s just that they’re monitoring their own effectiveness through a very simple procedure, and that PCOMS—those instruments are free online.

You can find them through the Heart and Soul of Change Project. Now on our Counseling Center we serve over—about 27 percent of our student body and 10 percent is the national average. We have—even though we have a small campus of a little over 1,150, we are very large for our Counseling Center. Our center received accreditation in 2009 and just reaccreditation this month, and so we’re recognized among our peers as an institution that provides high-quality care.

And eCPR and PCOMS are considered part of what makes our center strong and particularly student focused, so much so that the Dean of Students, our Provost—in fact I’m doing eCPR training for some of our staff in July and the Provost told me directly that he wants to participate in that eCPR training. So, on your screen you’ll see a list of resources. I strongly encourage you to take advantage of those resources and please—and there’s a link there to the Heart and Soul of Change Web site if you’re interested in accessing those instruments.

And of course you can always feel that you can contact me either by email, and there is both the UNCSA Counseling Web site and my personal Web site. Thank you very much and I’ve had a great time speaking with you.

Jane Tobler: Excellent, Tom. Thank you so much for sharing your efforts about how to create a supportive campus community and the support you’ve garnered from university officials on campus as well as the positive outcomes you’re seeing as a result of this, it’s really important. As people can see, your contact information is on slide 47. Your information is up there with the email and—as well as the Web site. And the next thing we’re going to do is we’ve asked each of our speakers to present what their vision is, so Leah, please go first, and Leah, if you . . .

Leah Harris: I’m sorry, I apologize. I couldn’t get myself off of mute. Yes, so my vision is really again, it’s what I started off with saying is that Emotional CPR would be as widespread as regular CPR, that—imagine or any lifesaving skill. I mean, if someone on a beach is drowning, likely someone on that beach, even if a doctor is not present, someone on that beach knows the skills to save that person’s life if a lifeguard is not present.

So the idea is really that the “emotional heart” is seen in our culture and society as important as our physical heart, and we—that we need both to stay alive. And then of course it gets back to what I said in the beginning again, huge, huge gaps in voluntary community resources in every single city in this country and rural situations, it’s a million times worse. So you know, we need to really increase access to voluntary community support that people can access before things get to a crisis point.

And getting back to the trauma-informed approach that really, you know, all first responders want to help. They don’t want to make things worse. So often they don’t have the skills. I mean, there’s great trainings that are out there, but we know, you know, crisis intervention trainings are not as widespread as they need to be.

So imagine, you know, a country where everybody from the police first responders to every single community member would be equipped to respond in ways that do not increase trauma, but actually facilitate individual and community recovery. So that is my vision and I hope that one day I can say that that is indeed the case in our country and in our world. Thank you.

Jane Tobler: Excellent. Thank you, Leah. Lisbeth?

Lisbeth Riis Cooper: My vision is that the healing power of a therapeutic community would become the basis for where people come to heal, that we’d get out of the pathology and into the recovery and into the therapeutic community, because I have seen it. I see it every day how people go on and go on and lead fulfilling lives because they’re accepted and met where they are.

It’s happening in community. I see it at CooperRiis all the time, and we have found that people who go through our program on the average have about 75 percent go on to lead a fulfilling life because they have become—they are human beings again. They are people with potential. They’re beautiful human beings. They are no longer a diagnosis. They are no longer their pathology.

We’re using tools that will help promote that and medication just being one of the tools in the toolbox, and I hope that we can get out of—and I listen to the news and people talk about the dangers of people with mental illness. They are more likely to get hurt by someone than they are to hurt another human being. When you go to third world countries, they allow—they accept people where they are and they take care of them in community.

I hope someday—I dream about the day where there will be a CooperRiis in every State, where the CooperRiis model will be what will be used in treatment for people with psychiatric or mental health challenges. That is my vision for anyone who has a family member or themself struggle with a mental health challenge. I have hope. Thank you.

Jane Tobler: Thank you, Lisbeth. Tom, can you please share your vision?

Dr. Tom Murray: Certainly. My—you know, all too often counseling centers are seen as being solely responsible for student mental health when in fact a public mental health model is much more effective. Colleges and universities are encouraged to provide a community-based collaborative response that elevates students’ voices and makes them a part of the decisionmaking process. All too often decisions about these emerging adults are done behind closed doors and they’re not privy to these discussions.

And of course, there’s the whole mantra within the disabilities community, nothing about us without us. And I encourage campuses to implement the public mental health strategies as a way of better serving students in emotional distress. My hope too is that campuses really look at their policies and procedures, but more importantly their own personal relationship with the idea of human suffering and emotional crises.

Rather than putting on a label regarding someone and saying that someone is bipolar or someone is schizophrenic, the labels only serve to give us that feeling of distance, which allows us to make decisions arbitrarily about their status, but rather when we get to know people on an individual basis we’re less inclined to give them barriers to receiving their education.

Now granted for many students that may mean returning home to their community where they can get the level of support that they need, and that certainly should always be an option, but that—college campuses can, do provide services that already are existing in a much more nurturing and supportive fashion.

And in closing I just want to reiterate, you know, there are ways of—within the counseling centers, PCOMS just being one of them, that has such a profound effect on capturing students who are at risk of premature termination, who are at risk of deterioration, who are—could get much more out of the service that they are getting just by elevating their voice, just by collecting feedback about the work that they are receiving. That’s my vision for mental health services within college campuses.

Jane Tobler: Great, thank you, Tom. As you heard and saw our speakers provided some great resources, and there are more on slides 52 to 57. There are also more resources available on the ADS Center Web site at promoteacceptance.samhsa.gov as well as the SAMHSA Web site. We are now going to move on to questions. To ask a question, please dial star one on your telephone to be placed in the queue. Tell the operator your name unless you don’t wish your full name to be announced.

Then only use your first name. You can ask questions also using our online feature at the top of your screen. Because time is limited, we ask that you only ask one question. So I’m going to go to our first questions that came in and the first one we received is “I loved the presentation on eCPR. It seems so natural not labeling people, treating them as an equal.

But how is this being received by conventional providers? Are trainings being done at mental health centers?” So I would ask you know, Tom and Leah, if you could respond to that, and then so basically this person is saying how are—how is the eCPR being received by conventional providers, and is this happening at mental health centers? Leah?

Leah Harris: Yes, this is Leah. It is happening, not as much as it needs to be. However, the reception has been overall extremely positive. We are not telling people, you know, everything you’ve done is wrong. You know, we are understanding that they come to this with so much heart and wanting to help and they’re grateful to have the tools and skills to be effective and to see the kind of outcomes that everybody wants, which is for people to recover their lives and live in the community and have you know, the ability to have the support they need to manage their distress and crisis. So that would be my answer to the question. We need more, definitely as I said. We’d like all people in all walks of life to have these skills and proficiencies. Thank you.

Dr. Tom Murray: I’ll—this is Tom Murray. I’ll just add that I am a conventionally trained therapist, and I feel like eCPR allows me to tap into the energy that led me into this profession in the first place, and I think that that would be true and is true for the other mental health providers that I know who participated in this training. And then it also reflects what the research says, you know that for example, in graduate training programs, first year graduate students are more effective in change than second year graduate students.

And the rationale is that with second year graduate students, there’s such an overemphasis on using theory and technique whereas the first year it’s really just connecting, building connections with the others and sitting with—being a witness to—all of those things are really what eCPR is about, so in many ways it is not a—it—I think it’s much more—can be seen as much more support service.

It’s just like, you know, if someone goes into cardiac arrest, you’ll have someone there who’s responding to it immediately, but you still get them to a provider to—for advanced care, if that’s necessary.

Jane Tobler: Excellent, thanks, Tom. We’re going to go to the phone lines. Operator, can you go to the next question please.

Coordinator: No problem. Our first question from the phones comes from Kent Earnhart. Your line is open.

Kent Earnhart: Hello, can you hear me?

Jane Tobler: I can, Kent, go ahead.

Kent Earnhart: Okay, yes, I’m a senior or seasoned mental health consumer advocate, and I’m very impressed with this. I actually went to the dedication ceremony at CooperRiis, but I want to ask Tom Murray about how that program might be implemented in the community or where courses might be taken. It so happens that I’m also a client of the UNC Department of Psychiatry, Community Services STEP Clinic in Raleigh.

And I’ve never heard of it. It just sounds like something they might want to do, NAMI-NC might want to do. So how is this getting out? Who’s—where would one get training?

((Crosstalk))

Dr. Tom Murray: Are you referring to eCPR or the PCOMS?

Kent Earnhart: I’m sorry, EC—the first one, eCPR.

Dr. Tom Murray: Well if anybody is interested in eCPR training can go to the emotional-cpr.org Web site and there’s links there for contact information and to have facilitators come to your community.

Jane Tobler: Excellent. Next question, please?

Coordinator: Our next question comes from Diane Lipman. Your line is open.

Diane Lipman: Hello, can you hear me?

Jane Tobler: Yes, I can, Diane.

Diane Lipman: Okay. I have seen many times difficulty in getting family buy-in, so I’d like to ask Lisbeth Riis Cooper how to engage family members who lack interest and willingness to learn, or which is another situation which is very difficult, when family members think they already know, so they don’t want to listen. They think they’re there already. And they shut down.

Jane Tobler: Great question. Lisbeth?

Lisbeth Riis Cooper: It’s a wonderful question. The first thing is to build trust, and that can be a lengthy process, but you need to trust your family member, they need to trust you. And some of it reverts back to the language, and also learning validation skills. Those were probably the most important thing that I had to learn, and there was basic DBT, dialectical behavioral therapy, where I learned to validate the emotions of my family member.

And because it takes the anxiety level right down, but building that trust, learning to validate, and also let your family member know what you are willing to do and what you are not willing to do. It just gets the cloudiness out of it and just have very clear—have a very clear foundation about your relationship, and that I think that will just make a huge difference.

It worked in my family, and this is one of the things that we tell families. We often refer to as families, build that trust and then learn to validate and then be willing to share with them what you will do and what you won’t do, what is acceptable and what is not acceptable.

Jane Tobler: Great, thanks, Lisbeth. The next question that was sent in says “I would like to thank all the speakers. My question is primarily for Leah. Can you talk a little more about what you mean by eCPR being culturally attuned?” Leah?

Leah Harris: Yes. Yes, thank you so much. Yes, I wish I’d had more time to go into that. I wanted to just give two quick examples. So my mother was diagnosed with schizophrenia, and a lot of her, you know, what are called delusional thoughts were about the Nazis and her doctors being Nazis, and her whole experience was that people were like, you know, this is not true. You are wrong. There’s no Nazis. You know, just total not validating her experience.

And a culturally attuned approach would say, oh, you’re a woman of Eastern European Jewish heritage. Your family’s been affected you know, by the Holocaust and by the Nazis and you know, trying to understand where she is coming from, you know, in a cultural way. And so that is you know, not—it’s not what’s ordinarily done. We don’t usually go that deep, but a culturally attuned approach understands the power of intergenerational and historical trauma and how that can affect a person’s response to crisis and distress.

And then another quick example from a book called Shadows in the Sun by Gayathri Ramprasad, and she is a woman of Indian heritage, and she was hospitalized for being suicidal, and she had around her neck a necklace called the Mangalsutra which is a very powerful symbol in her culture of marriage. And she got it on the day she was married, and to take this necklace off symbolizes that you are now divorced.

And she loved her husband. She didn’t want to be divorced, and the staff insisted because of the suicide risk that she had to take off this necklace. And she talks about it in the book in great detail about that just absolutely exploded her crisis and distress to a whole other level because it just added this whole level of fear about her marriage and no longer being married.

So all this to say that you know, they could have adopted a different approach where they saw how this is so deeply culturally significant to her and found a way to A, you know, maintain safety for everyone while at the same time honoring that this necklace has a deep cultural significance for her. So those are just two quick examples that I wanted to share in that regard.

Jane Tobler: Excellent. Thank you. Operator, can we go to the next question on the phone, please?

Coordinator: Yes, our next question comes from Corinna. Your line is open.

Jane Tobler: Corinna, if you’re there, we can’t hear you speaking.

Corinna: Yes, this is Corinna.

Jane Tobler: Okay, we hear you.

Corinna: My question is, if we’re going to spread eCPR throughout the country, is there a plan to imitate other community-wide programs, like for instance the Heimlich maneuver is super simple but it had—it required a pretty sophisticated marketing campaign to actually get people to know how to do the Heimlich maneuver when people are choking. So not—we don’t just need an idea, we need idea champions and marketing approaches. So what are those plans?

Jane Tobler: Excellent. Do I hear a volunteer? Tom, do you want to address that?

Dr. Tom Murray: I think Leah would be the better person to address it.

Jane Tobler: Okay, Leah?

Leah Harris: Yes, thank you. So you know, this is a program that is still, you know, being established and definitely I couldn’t agree more with the caller that you know, in addition to the actual training we need excellent marketing and sort of get the word out. We currently welcome resources to do that and I’d be happy to talk to you or anyone further about how we can connect up with some of that assistance, so thank you.

Jane Tobler: Excellent. Operator, can we go to our next question please?

Coordinator: Yes, our next question comes from Marilyn Danos. Your line is open.

Marilyn Danos: Hi. Good afternoon. And it’s Danos. My question is, how can an employee or a student on a college or university campus create change if overall the president of that college or university, the administrators including deans and vice presidents of counseling services on the whole and even including faculty and counseling on the whole essentially can have stigmatized students, discriminated against students, and caused even more self-stigma for those students?

And I say this clearly and not really meanly or mean-spiritedly, but I was an employee and a student of a community college where I worked for 20 years, fine student, honor student, plugged away for many years at that college for 8 years, finally getting my associate’s degree and going on to getting a baccalaureate in behavioral studies and then a master’s in human services counseling with a minor in career counseling.

As a student, I was not ever stigmatized, ever, but then my faculty, my professors, didn’t know that I had depression. However, my boss, the people above her knew through HR that I did. When I was hospitalized for 3 months, and summarily 1 year to the exact date that I came back and worked my butt off was dismissed after 20 years of service, terminated without thought or precedent, didn’t care.

I was no threat to anyone. I was more a threat to myself, so I want to know, how do—now even me, a person who loved that community college, who loved the students, first-line person helping them, teaching them career development theory and exploration, case manager and so forth and so on, and know that I did self-stigmatize myself, I know that, but I’m not there any longer.

How can one, even an employee from the past or a student from the past can prompt leaders in that community and as well in that community college that serves a vast portion of students, how? How does one singly do that? Because the counseling services at community college frankly are very good but not adequately for students or employees who have mental health issues. That is what it is.

Jane Tobler: Right, that sounds really grating. Tom, can you address that?

Dr. Tom Murray: Sure. That’s—well, first, you know, I’m sorry that you had such an experience. That already being distressed and then having that on top of it is—can be overwhelming. You know, there are two things. One is that many community colleges, and I started my career in a community college counseling center, are often under—their focuses may not be on clinical services.

And so they may have a much more academic advising function than an actual psychotherapy function. In my counseling center, you know, we do psychotherapy. That’s our main function, so I can’t speak to your specific situation, but just my experience within higher education and within community college counseling centers, that’s a concern.

And also it’s really weird to see administration want to emphasize or put their energy, so again if you’re seeing students on a one-to-one basis and you’re not available to do the outreach and the programming, so you know, it is the core mission of the institution for—to provide that level of service, and if so are they adequately—that is, the staff, are they adequately equipped to provide that service?

I think by and large student affairs personnel and college administrators are really wanting students to be successful and are eager to get people through their academic career and graduated and employed. And yet they are certainly a product of our culture, and our culture as a whole has this very distant—you know, a distant space if you will between people who are viewed with such labels and people who are not, when in fact if we were to see it as a normal reaction that psychiatric symptoms are really a normal reaction to abnormal life experiences, then we can connect to people on a more personal level.

So to how does this integration happen—well, there are faculty on college campuses for whom this is their personal story as well, and many campuses have clear procedures for students to organize. My campus for example has a procedure for students to take eCPR and to be formally recognized by the institution. And I know that that’s true for many campuses.

So using the current structure is always a good starting point, and then finding people who—for whom this fits with them. It may be—it may be challenging to get the very top administrator’s attention, but you know, people who are working directly with students, I think there’s a general receptivity and a desire to feel more competent in working with distressed students in the large part.

Jane Tobler: Thank you. The final question that we received, I’m going to give to you, Lisbeth, because we’re almost out of time. Although this has been a great discussion, this person wrote that they were shocked to hear you say that 80 percent of families have never heard about recovery. What can I do about that? And I think she meant it in the “I” as a member of the regular community?

Lisbeth Riis Cooper: Well, speak up. Speak to everybody about it. Let—speak about recovery being possible, and that’s the first part. Speak about your own experiences. Share your own story. It’s very powerful to hear someone else’s story and so you’re not alone anymore. I find with families all the time to—that when they come to CooperRiis, it’s the first time they’ve had an opportunity to share their story with someone because of the shame and the stigma they experience.

So for starters share your story openly. Let people know that there’s help out there, but there’s—more importantly there’s hope that everybody can recover. Your family member may be somebody that hears voices. Normalize that situation. They may have some anxiety. Try and normalize that. Normalize what they are going through, and speak about it in positive language and not in diagnostic language.

Speak about yeah, my son has or my daughter has this mental health challenge. Here’s how you can support them. Here’s how I support them, and they have potentials just like anyone else, and but I think that we also—we are all in the closet about mental health challenges, and when we hear this negativity on the news and like we just unfortunately heard from California, this horrible story, it just again stigmatizes us.

But we can all put in a positive voice and get the permission also of your family member first to allow to share your story, which is so important. I had to do that all the time with my daughter, and I have to get that permission, but we got to talk about it, we got to talk about it in positive terms. We got to talk about the fact that hope is the forerunner of change. Hearing voices, well it’s not such a big deal, so normalize it.

It may be annoying. Sometimes we teach our residents to make appointments with their voices, Hearing Voices Network, and get involved in the recovery- oriented groups and get in—take the class of Families Healing Together. Now you’re not going to be alone anymore. And these are all little steps in the right direction, but the most important thing is learn to speak about it in a positive way so other people can become civil. Every time I share my story, people come to me privately and say this happened to me or this is what’s going on in my life. Thank you for speaking up.

Jane Tobler: Thank you, Lisbeth. And I’m going to just share one comment—more comment that we received, which is appreciate your sharing about the naturalness of the process of reaching out and the community reaching to support people with emotional distress. It is nice to relax, join with, and validate people. And then this person goes on to say it’s such a relief to hear that systems are coming around to truly helping individuals in need at a level that makes sense to the body. Just thank you.

Okay, thank you for sharing that comment. We all really appreciate it. I do want to thank everyone for the questions and answers. If we weren’t able to take your question, reach out to the speakers directly or contact us at the ADS Center at promoteacceptance@esi-dc.com. You can read more about the speakers on slide 60, 61, and 62. We do value your feedback so within the next 24 hours, you’ll receive an email request to participate in a short, anonymous online survey about today’s training.

It will only take you about 5 minutes to complete so please take the survey and share your feedback with us. This information will be used to determine what resources and topic areas should be addressed in future training events. This conference has been recorded and the video archive as well as the closed-captioning and transcripts will be available in late June on the SAMHSA ADS Center Web site.

If you enjoyed the training, we encourage you to join our ADS Center listserv to receive more information on events such as these. And to learn more about SAMHSA’s Wellness efforts, go to samhsa.gov/wellness. On behalf of all of us at the SAMHSA ADS Center, I want to extent our sincere appreciation to Leah Harris, Lisbeth Riis Cooper, and Dr. Tom Murray, for being with us today, for doing this information, sharing this information with us as well as just doing the great work that you’ve done.

We really appreciate it. It’s obviously making a difference, and I think that was obvious from that—from the call today, so thank you so much and finally thank you to all of our listeners for caring about this subject, caring about this topic, and taking some time this afternoon in your day to join us. Thanks finally in advance for completing our survey. Goodbye.

Coordinator: That concludes today’s conference. Thank you for participating. You may disconnect at this time.

END