Deinstitutionalization

When you read story after story in the News & Observer chronically pining about deinstitutionalization and the lack of services in the community for the mentally ill, what they’re complaining about is the lack of comprehensive care.

One in four of us will experience some form of psychiatric illness in our lifetime. This statistic alone communicates how widespread and common it is for any of us to fall prey to depression, an eating disorder, anxiety, substance abuse, or a psychotic disorder.

For one in seventeen of us, mental illness will be severe. Severe psychotic illness most frequently comes early in life—in youth, when individuals are their most productive. Not only is the productivity impaired, but the nature of the brain disease also damages insight, cognition, and behavior.

A young person discharged from a hospital after being temporarily stabilized, gets released into the community with no plan, no job skills (never got a chance to learn them with the illness hitting so young), and no rehabilitation focusing on their illness and behavior, is destined to fail.

For all of the limitations of a hospital, it did provide comprehensive care. Caramore provides comprehensive care. Caramore is the community service that people wish existed for the mentally ill.

Caramore attempts to provide comprehensive assistance for as long as it takes. We centralize medication, shelter, food, therapy, and rehabilitation in one place and we do it for the length of time necessary, and to the degree necessary.

There is no cure, but almost all brain diseases can be treated, and part of the treatment requires (along with the traditional model of drugs and doctors) comprehensive and intensive support and rehabilitation. The beauty of Caramore is that it is not a hospital—it’s essentially the real world, with real jobs, real friends, and real apartments. But it provides that underling helpful and watchful guidance. We find that our clients want to be independent—not dependant, and when they gain the maturity and perspective regarding managing their illness, they rise to the occasion, attempting to achieve all that they can, while remaining aware of their illness.

Our model is worth copying in all communities.

D. Cooley

What Caramore is not

Caramore is not a group home.

Caramore has two homes that serve as the first stop for incoming clients. These homes house all new incoming residents and are designed to provide a stable and structured environment where all that goes into “living” (chores, social interaction, nutrition, cooking, hygiene, etc.) can be gradually addressed. But within weeks, many of our clients find themselves in a large two bedroom apartment that we manage. No one lives in our homes for long, they're just the first step.

Caramore is not a clubhouse.

Caramore has two in-house businesses that are actually for-profit competitive services in Chapel Hill and Carrboro. All of our incoming clients begin working on these jobs to gradually address stamina, work-place etiquette, and employment soft skills. But these jobs are temporary and exist to prepare our clients for a more permanent job in the community. Besides, these guys down the street do the clubhouse thing better than anyone else.

Caramore is not for everybody.

All potential clients visit Caramore for at least a week prior to coming in officially. Many individuals, in various states and severities of their illnesses, are simply not ready to try and work in the Caramore environment. That’s why we are a small program and why visits are essential. But just visiting can be valuable—it demonstrates, through our feedback, exactly what is needed to improve, and what should be worked on, to eventually gain admission.

Caramore is not an easy program.

The real work begins after getting admitted. Our clients must be willing to work exceptionally hard to manage their illness, their work, and life. Nothing is guaranteed. Entrance into program offerings like Tier 3 are not automatic, but are contingent upon consistent effort and a motivated attitude. Most find though that genuine effort brings great rewards at Caramore.

Caramore is…

A highly supportive environment and a loving group of people that strive to provide just the right help to each client we serve; to gradually, in stages, and to the extent that each individual needs and desires, promote progress, wellness, rehabilitation, and independence.

D.Cooley

Creative, flexible, and adaptive

Caramore has the honor or serving extremely unique and rare individuals. Illness is experienced and manifests itself very differently in each individual, making meeting people who come to Caramore a new adventure each time.

Experiences of mood disorders and psychotic diseases are traumatic and tragic—but they also can be fascinating, unimaginable, and humbling. The struggle to overcome illness is heroic and inspirational to be a part of.

It truly takes a team to take on this illness—and time. Treating it requires being creative, flexible, and adaptive. No one approach is always appropriate—each individual is frustratingly one-of-a-kind; but that’s also the challenge and source of satisfaction. Each individual necessitates being known within the context of who they are and what they need, and getting to know them is part of the fun.

How do you re-teach someone every little messy and complicated life-circumstance that the rest of us take for granted? It’s no science, and it begins simply enough with being kind and listening. It takes an open mind and a willingness to approach each person as needing something wildly different from the last one—and the reward for that openness is gaining a new friend.

D. Cooley

Police Crisis Intervention Teams

NAMI has been doing a wonderful job advocating for Police Crisis Intervention Teams (CIT) to be adopted in all communities.

What is a CIT program?

-CIT is a partnership between the police, the mental health system, family members and individuals suffering from mental illness.
Certain officers within a force who have an interest and insight into psychiatric illnesses, receive specialized training from mental health professionals and advocates .

-They are taught to recognize psychiatric distress and symptoms that accompany the disease, and the types of techniques and responses that best work to de-escalate the situation rather than compound it.
The goal, through recognizing psychotic symptoms and dealing with them appropriately, is to get the individual into the proper mental health treatment rather than arresting them or anyone getting hurt.

-Implemented in communities (Memphis, Durham, and many more), the program greatly reduces the rates of arrests and injuries for those with mental illness; and it improves the understanding and compassion and satisfaction for officers working within those communities.

The existence of this program is an encouraging example of the gradual progression of societal awareness concerning psychiatric brain diseases, its symptoms, and how best to help someone suffering from them.

D. Cooley

Caramore offers immediate jobs

If you are appropriate for our program, Caramore gives you a real job the minute you walk through our door regardless of your illness, past, criminal record, education, or lack of references. You immediately begin making money and have a place to live in one of our two family-oriented homes.

Our landscaping and professional cleaning businesses are real for-profit services valued in the community and will serve as an excellent reference for your next job.

We give you a real job and a comfortable place to live—with low hours and low stress— to gently get you accustomed to working, living, and interacting socially again.

But it’s all very temporary. With the right attitude and effort you may be—within just weeks—ready to interview for a job in Chapel Hill or Carrboro, and move to our apartments to enjoy a greater degree of personal freedom.

Caramore provides the job and a great place to live first, and surrounds it with intensive support and treatment coordination to ensure your success.

D. Cooley

Caramore's mission

Caramore’s mission—written at the top right of this page—is to aid those suffering from psychiatric diseases.

Our mission and services are centered on providing a response to mental illness. This blog has stated our medical, rehabilitative, and ongoing illness management responses to the illness—responses that are at the same time scientific, ethical, and practical.

But there is another vital response needed—that of battling stigma. Slow realization, agreement, and acceptance of all that can go wrong with the complex brain; and the natural bewilderment of trying to understand distorted behavior altered by brain diseases, add up to a society that at best doesn’t understand, and at worst feels extreme discomfort.

Certainly the illness deserves anxiety—considering that we’re all vulnerable to depression and anxiety just as we are to heart disease and cancer. As we pass from youth into adulthood, limits to our healthy functioning begin to make themselves known. Our own imperfections, misfortunes, and limited suffering awake in us the realization that many others are suffering.

And to have a mental illness is to suffer—as millions do. But then to be marginalized and shunned by a confused and uncomfortable society, simply for having a hereditary illness—well, it doesn’t get any worse than that.

Caramore’s response to this is to be an organization based on inclusion. We believe that the most important first step in reversing society’s uneasiness—is to show them how easy it is. Caramore’s “community” is one in which having a mental illness does not mean exclusion or limitation. We seek to embrace, incorporate and include. Through camaraderie, relationships, expectations, and opportunity, we seek to not only pull people out of a debilitating illness, but show the obvious: we’re dealing with ordinary yet capable people who have a treatable disease.

A growing number of our clients—because of performance, attitude and effort—go on to work for us in permanent positions. These merit-based achievements we talk up precisely because we believe they are an example of our mission—to change society’s perception of mental illness.
D.Cooley

Study: Drugs don’t help enough

An article in today’s News & Observer says that for mental illness, drug therapy is not enough. It needs to “be accompanied by intensive support, including family counseling, vocational training and regular contact with doctors and other professionals."

Caramore has been providing the response needed for mental illness—and we’ve been doing it for 30 years. Here are the three responses that severe mental illness demands:

1. Medical Care. All forms of serious psychiatric disorders and diseases require ongoing medical treatment.

Caramore serves as a liaison between our clients and psychiatrists, therapists and pharmacists. We monitor all medication to ensure all prescribed medical treatment and therapies are being followed.

2. Supportive Environment. In severe cases—like schizophrenia—where cognition and behavior and insight have been impaired; rehabilitation is required. It can take a long time to relearn, readjust, and regain normal functioning. A structured environment that’s normalized, full of routines, expectations, and social interaction, is vital.

Caramore provides a rehabilitative setting that is supportive and encourages and requires direct effort and participation—the goal being to re-establish a meaningful life in our community.

3. Ongoing Illness Management. There is no immediate cure for hereditary psychiatric disorders. The illness can, and often does, return in degrees. But the chances of re-hospitalization can be reduced. Ongoing illness management entails living a healthy lifestyle, continued medical treatment, and remaining associated with support—support that helps limit isolation, ensure that the prescribed and correct (and often complex) medication regimen is being followed, and providing assistance in preventing small everyday life-problems from becoming large and un-repairable (like losing an apartment or a job).

Caramore offers long-term association with us that entails housing, medication management, psychiatric care coordination, along with employment, financial, and health care counsel. We work hard to ensure progress is continually gained and not lost during unfortunate twists and turns of the illness.