This is a six-minute synopsis of the hour-long presentation that Denis Antoine, M.D., FAPA, FASAM, presented at the Johns Hopkins Medicine Psychiatry Grand Rounds on “Stigma and engagement in underserved populations: meeting mental health and substance disorders needs in the community”.
The Life Story Perspective focuses on the Settings, Sequence and Outcomes that a person may encounter over their life and how that might play a role in their mental illness or substance use disorder. Using this perspective, providers can try to find ways to rescript the setting, sequence and outcome that might better fit the person’s background and hopefully maximize the person’s success over time. Dr. Antoine shares his experience of how serving at the community setting helps overcome obstacles and improves the outcomes for individuals.
Good morning. My name is Dr Dennis Antoine. I'm assistant professor in the Johns Hopkins University Department of Psychiatry and Behavioral Sciences, And I'll be talking today about life stories and engagement in underserved populations. Trying Thio meet the needs in the community overall. Within the department, we talk about a life story perspective, which is a portion of the bigger issues that can go on in a person's struggle with mental illness and substance use disorders. The life story perspective particularly focuses on the setting sequence and outcomes that a person may encounter over the course of their life and how that might play a role into their mental illness or substance use disorder. In this case, we try to find ways to re script. They're setting sequence and outcome to find better ways that might fit the person's background and hopefully maximize their success. Over time, there could be difficulties along the way, however. One is stigma, and at its core, stigma is defined as a mark or a tattoo that might be put on a person and might devalue them over the course of their life, making it difficult for them to reach the previous level of value that they had before or the value that they would like to reach. And overall, 1 may think that those are internal factors, personality and other things. But there are also societal factors that we have to take into account, one of which is the fact that many people who come to our doors for psychiatric services often get misdiagnosed on. This has been long noted in the literature as recently as two years ago, when in February 2019 who has shown that there's ah, large portion of African Americans that are misdiagnosed when they come in for behavioral health services. Additionally, we have to think society about the criminal justice system. This graph shows the rate of incarceration has increased dramatically, especially since 1970 where the controlled Substance Act was implemented, and since then there's been a large increase in incarceration. More specifically, when thinking about the sequence in the setting for persons, there has also been a disparity and who has been incarcerated so you could understand how this could leave a mark and a potential devaluation on persons in their ability to achieve subsequent success in their lives. So as we try to re script people's lives as they come into our doors or as we encounter them for treatment. It's important from my standpoint that we think about some of the non specific factors that Jerome Frank identified in his book Persuasion and Healing. These Air Factors between a provider and an individual that should be really striven for so that there could be ideal outcomes feeling understood, feeling respected, making sure that the individual coming to us for treatment has someone that is interested in them and being encouraged to face the difficulties and overcome them and overall being accepted and forgiven. Not all of these things are part of the typical D S M five typology or part of our certain types of therapies. But they're very important factors that as we try to re script the sequence that a person undergoes to get better in their lives, thes should be incorporated. And then, in terms of the outcome, it's very important toe. Make sure that we think broadly about what account outcomes were looking for. Recently, a group of individuals came together to try to provide a definition that could be, ah, working place for us to strive within our science and also in our clinical efforts, and they came up with this definition that recovery is an individualized, intentional, dynamic and relational process involving sustained efforts to improve wellness. And while there's nothing wrong with this definition and it is a great working definition, Thio begin our endeavors to improve the field. I feel like there needs to be more into the details as to what a person can do to re script their lives again, sticking with the setting sequence and outcome of our clinical endeavors. So in part, I've done that by being the director of the Cornerstone Clinic in helping a mission that began in 2012. And what we did is we changed the setting and that we brought a clinic to a homeless therapeutic community in Baltimore and open the clinic on the fourth floor of that facility, and we offer substance abuse and mental health treatment there, and we treat only the people in the building so that there is the bandwidth toe. Make sure that we have adequate access for people who come there for homeless services and other therapeutic services that are available, and what we found is that by working with the community very closely and communicating with them and meeting their needs that we've been able to engage them at a high rate of of treatment, which is very essential to keep them moving towards the track for improving their lives. And overall, we've also seen that it's improved retention within the building by almost 55 days, and we've seen that people who have been in our clinic are more willing to stay around for all the services that are provided there. There is a primary care. There is substance use disorder treatment and also mental health treatment available. And people who are in this co located space for treatment tend to stay around longer, which has been very helpful. But then we still need to think about what is the outcome that we're looking for. The setting can be changed in many ways. So can the sequence if we have different types of providers or different types of outlooks and how we interact with our patients and clients. But in terms of the outcomes, I think it's still very important to make sure that we get towards how comes that go beyond just decreasing symptoms and decrease in drug use. We need to think about the things that are barriers to individuals being comfortable coming to our doors. And that is where things like medical mistrust, cultural understanding, self efficacy and also the removal of barriers to research and clinical disparities must be explored more because ultimately the definition of all illnesses and GSM five come down to social dysfunction. And if we're not able to ultimately reintegrate people into the fabric of society where they've often been marginalized, that is not the outcome we have adequately addressed yet. So I feel that we should look more into outcomes that address social reintegration. So thank you for your time and appreciate you listen.
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