Cottage Farm Centre - Proposal

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COTTAGE FARM CENTRE FOR MENTAL HEALTH

PROPOSAL FOR A CARING COMMUNITY WHERE PEOPLE FIND PURPOSE, HEALING AND WHOLENESS

Working Draft

Cottage Farm Centre Main Page

Contents

EXECUTIVE SUMMARY

A PERSONAL EXPERIENCE

The idea for the Cottage Farm Centre was stimulated by the experience of Ben, a young man who began showing symptoms of schizophrenia in his late teens.

Before he started on a regime of powerful drugs and numerous hospitalizations, Ben's mom Alison took him to the Yasodhara Ashram near Nelson, BC. There, as part of a wonderful team of retreatants, youth and residents, he worked burning brush.

As the gentle chatter of people doing meaningful work surrounded him, Ben showed significant improvement. He went from being hunched over, frozen in fear and indecision, to striding through the grounds, shoulders back, intent on his purpose.

While the ashram environment alone would not have been enough to make Ben well, research suggests that his well being would have been greatly enhanced if he had been able to continue his recovery in similarly warm and caring environment - a residential therapeutic community where he wasn't just a patient, but a contributing member of its society.


WHY A RESIDENTIAL THERAPEUTIC COMMUNITY?

Ben's experience, and that of many people suffering from mental illness, illustrates a glaring gap in the Canadian mental health care system. It demonstrates the need for a residential therapeutic community (RTC) where clients, professional and support staff, and volunteers alike would work together in therapeutic, task-oriented teams. They would live in a farm-like community, surrounded by nature.

  • The primary purpose of the community would be to provide a compassionate, respectful, and fulfilling home where people with a mental illness could live meaningful satisfying lives, recuperate and move on.
  • The secondary purpose would be to provide a grounding and healing environment for everyone who lives and works there - where attention to the moment and the practice of respect for all form the foundation upon which the entire community rests.

The present system of care sees the mental health recovery process moving clients from hospitalization to supported housing (a group home) to independent living. While this solution works well for some, as many families know, for others this process can result in a bleak, lonely, and fearful existence for the mentally ill. Unfortunately, for some independent living can mean a hotel room in skid row or living on the street. It's estimated that __ % of people living on the street suffer from mental illness.

However, even for those not plagued by delusions and cognitive deficits, just a week in a hotel room in skid row would be almost intolerable. Furthermore, men and women recovering from mental illness are frequently frightened, confused, and rendered almost helpless with apathy, which makes it particularly difficult for them to cope in such surroundings. Yet they have a great need for deep and meaningful emotional connection, purpose, spiritual sustenance, and community.

Indeed, it is when they are challenged by profound cognitive deficits that these elements may be more important than ever.

A residential therapeutic community, where people with mental illness could live and work for up to five years, would provide such support in a way not possible in group homes. The following information presents a model for such a residential therapeutic community.

Cottage Farm Center for Mental Health proposes a community where gentle practices such as mindfulness and awareness promote the wellbeing of all involved - a system where individuals are gradually empowered to take responsibility for their own recovery to the point where they can transition successfully back into mainstream society.

OVERALL CONCEPT AND PHILOSOPHY

While there are no residential therapeutic communities in Canada, several operate in the US. These include Gould Farms (www. gouldfarm.org) and CooperRiis (www. cooperriis.org). These organizations operate under the premise that if the client is unable to heal enough to live well in society as it is, then we must change society to meet the needs of the client.

The central concept is a living environment where staff, clients and volunteers live and work together as a functioning community. They live together in an organized and structured way to promote change. To this model are added the elements of modern psychiatry, with an emphasis on relationship-centered care and a strong compassionate, holistic component that affirms and honours the "whole person."

Their facilities include a small-scale farm, a central gathering house with a large kitchen-dining room, and a family room with comfortable chairs and a fireplace. The gathering house has several smaller rooms for individual and group therapy, relaxation and living-skills development.

Living quarters are in small cottages where each client lives with several other clients and at least two workers. All staff and volunteers are trained in the principles of compassionate care.

In such communities, work in a natural environment provides purpose and healing. Everyone works and is needed whether as a gardener, as kitchen help, as a psychiatrist or a recreational therapist. Work is not considered labour, but a gift that all involved both receive and give.

Work teams are made up of both well and ill, whose task it is to attend to the work and each other, as well as they are able. Healing comes gradually as clients tend thoughtfully to their work, their co-workers and themselves, supported by professionals and trained volunteers.


COTTAGE FARM'S VISION AND MISSION

A group of concerned citizens has created a non-profit society called Cottage Farm Centre for Mental Health Society. The goal of the society is to create a residential therapeutic community for the mentally ill with the following vision, mission and purposes:

Vision

A healing farm community for people with mental illness

Mission

Cottage Farm will be a caring residential community where innovative therapies combined with meaningful work in farm-like surroundings help restore mental health.

Purposes

  1. To provide innovative residential care and healing work for people with schizophrenia, bi-polar and other forms of severe mental illness
  2. To provide a setting where clients live, work and move toward health and wholeness alongside professionals and volunteers
  3. To fill a gap in the Canadian mental-healthcare system and reduce overall costs
  4. To equip clients to reintegrate into mainstream society within two to five years
  5. To be a model for therapeutic communities throughout BC and beyond
  6. To research innovative, effective mental-health therapies
  7. To reduce the stigma of mental illness by creating common ground between those who have been labelled mentally ill and those have not

PHYSICAL ENVIRONMENT

Cottage Farm would start small with clear and specific expansion criteria. The first phase might house up to 18 clients plus adequate staff and volunteers. It would have a land base of at least eight acres located within 45 minutes of currently available mental health resources. At least six acres would be set aside for growing crops, tending animals, and other such agricultural pursuits. The other two acres would house a central gathering house and a number of cottages.

The central gathering house would have a large kitchen and dining room, and a large gathering room with comfortable reading chairs and a fireplace. This gathering house would also have at least two smaller rooms available for individual and group therapy, relaxation, schooling, and living-skills development. To allow for close communication between the therapeutic and management aspects of the community, the central house would also provide offices for the mental health staff.

Living quarters would be in small cottages where each client would live with several other clients and workers. One cottage would be appropriate for any client who might move into an acute condition requiring close monitoring in a safe, secure environment.

DAILY ROUTINE

Cottage Farm's intake process will be rigorous and thorough, with a careful match being made between clients' needs and program design. The program will give clients what society generally denies them - a sense of responsibility, control over their lives and opportunities to participate fully in diverse and fulfilling work and activities.

Healing for clients will occur in the daily work teams and routines. Clients will choose tasks that suit their current capabilities, which could include gardening, household chores, kitchen activities, animal care, candle making, weaving, dog training, etc. Throughout the day, each team member, as they are able, will model care and attentiveness to a job well done, and gentle compassion for the rest of the team.

During time for reflections, clients, professionals and volunteers alike will have an opportunity to write about and reflect on their work, and to share their thoughts with others. Again, workers will model openness and willingness to self reflect, helping everyone learn to deal with the frustrations, anxiety and joy associated with daily living.

Throughout their stay, clients will gradually take responsibility for themselves and, as they become ready, for others clients. For example, a client might work in a gardening team when he or she first arrives, and be closely attended in his or her tasks. After a few months, as clients improve, they would be invited to show new clients how to do some of the gardening tasks, which they by now know well. Later, they might be invited to take on leadership roles on the gardening team, and participate in meetings as valued and experienced voices.

A typical weekday routine would involve a variety of work/play experiences such as psycho-educational therapies, educational coaching and work training programs, access to expert psychopharmacology, access to volunteer community service opportunities, nutritional and physical exercise coaching, individual and group psychotherapy, and relaxation time. Weekend schedules would be somewhat less demanding, but throughout the entire week, structure and routine would be integral to the daily regimen.

CLINICAL PROGRAM

The proposed Cottage Farm clinical program will be modeled on that of Cooper Riis, a successful residential therapeutic community in North Carolina. It will consist of multiple components including a variety of group and individual therapies. Staff and volunteers alike will be trained in the recovery process methods so as to facilitate each resident's recovery to the point where they can successfully transition into mainstream society.

[The following summary of clinical program information comes, with permission, from Cooper Riis. More detailed information on the Cooper Riis clinical program is available on the CooperRiis web-site.

Recovery Philosophy

Cottage Farm's recovery philosophy will be based on the belief that individuals with severe and persistent mental illness undergo a recovery process much like those who experience other types of chronic health conditions. It will go well beyond basic functioning to address issues of personal empowerment, connectedness with others, creation of a healthy sense of self, purpose in life, spirituality, and overall quality of life issues.

The recovery philosophy proposes three basic phases of the recovery process. The initial phase of recovery is characterized by achieving a stable sense of acceptance of one's illness as opposed to the pre-recovery state of minimization and denial. Developing a sense of hopefulness and inspiration is a critical aspect of this phase, along with developing the desire and motivation to move forward.

The middle phase of recovery is characterized by multiple processes including discovering and fostering a sense of empowerment, gaining new perspectives about oneself and one's illness, and returning to a level of basic functioning that might have been left behind due to one's symptoms. To achieve a sense of empowerment, people with persistent mental illness begin to take more control of their own recovery process and of their own lives. Instead of depending on others for their day-to-day needs, they begin to accept more responsibility for their own care. Gaining more insight into their illness and learning to self-monitor and to initiate proactive strategies to control their symptoms also increases a sense of empowerment. Recognizing and discontinuing harmful coping strategies such as substance abuse or poor eating habits is part of this process as well. Empowerment also entails developing certain positive attitudes like determination and confidence.

The third phase of recovery entails striving for and attaining a stable sense of well-being and a better quality of life. This process often includes developing a stable and positive sense of self, a sense of inner peace, a sense of overall emotional stability (including decreased symptoms due to improved coping and symptom management) and positive attitudes and beliefs that are not transient. Developing a sense of meaning and purpose in one's life is also a part of the later phase of recovery and can be related to one's roles such as serving as a mentor for other people who are in less recovered states. Obtaining a sense of independence and self-sufficiency is also a part of this phase along with more concrete standard-of-living issues such as being able to afford a home or being able to afford leisure activities.

The clinical program will be designed to facilitate movement through all phases of recovery, and recognizes that residents may be working on aspects of all three phases simultaneously.

Recovery Service Plans

Seven recovery domains will be key components of the recovery program including Community/Connectedness, Spirituality (i.e. one's sense of inner peace and harmony), Physical Wellness, Emotional/Psychological Health, Purpose/Productivity, Empowerment/Independence and Intellectual/Learning/Creativity.

With the help of a clinical team member, each resident will create long- and short-range goals in each of the seven domains. A responsible professional or volunteer will assist the resident in achieving that goal and help evaluate progress. By intentionally focusing on all seven domains, the program will provide holistic and balanced care for each individual and will support and facilitate the recovery process from multiple angles.

Formal Components of the Clinical Program

Cottage Farm will be very intentional about creating an overall therapeutic milieu that surrounds every resident with multiple sources of support and multiple opportunities for growth and recovery. These will include individual therapy, group therapy, addictions support, family support and education, psychoeducation, wellness and education counselling, and medication evaluations and monitoring. Residents will be supported with attitudes, actions and interventions. This interrelated, multi-faceted approach will work toward the enhancement of recovery.

Other Programming

Other components of the therapeutic program could include:

  • Work training programs - each resident will be assigned to a work training programs such as housekeeping, farming/gardening, maintenance, art barn, kitchen, or produce stand.
  • Community service, education, work, and internship opportunities - after clients have successfully managed the work program, they may become involved in the broader community. Based on their needs and interests, they may participate in any number of educational, internship or work opportunities.
  • Arts and recreation program - clients will be offered many arts and recreation opportunities on a daily basis in both a structured and unstructured format.
  • Evaluation of clinical programming - various methods of program evaluation will ensure continuous improvement in programming on both an individual resident level as well as a programmatic level.

Transitioning Into Mainstream Society

Cottage Farm's programs will be designed such that clients will be equipped, as far as possible, to reintegrate within two to five years into mainstream society. To facilitate the transition, they may live in a nearby apartment leased by Cottage Farm, or in their own apartment or house. Support services appropriate to each level of independence will include facilitation of vocational, educational or volunteer opportunities, psychiatric and psychological services and continued recreational opportunities. Respite care at Cottage Farm will also be available as needed.

Additionally, we will encourage long-term communication with our program through a toll-free phone line, and provide residents with permanent Cottage Farm email accounts. The follow up will also include structured progress checks and outcome data collection on an ongoing basis.


INTERACTION WITH THE COMMUNITY

As is already happening in many neighbourhoods in BC, the mentally ill at the Cottage Farm Mental Health Centre would live peacefully and without incident, both within Cottage Farm itself and within the surrounding community. However, Cottage Farm would have many characteristics that might make it an even better neighbour (than traditional group homes) within its larger community.

Some of the benefits and advantages could include:

  • Cottage Farm would draw many of its staff and volunteers from within the larger community, providing economic and social benefits.
  • A coffee shop, vegetable stand or some other type of commercial venue for Cottage Farm produce, baked goods etc. would provide an opportunity for clients to interact with the neighbouring community.
  • Cottage Farm clients would volunteer in the community, perhaps by distributing produce to shut-ins and seniors, or other similar undertakings, or even work on contract as they are able.
  • Cottage Farm facilities could be used for multiple purposes such as facilitating community concerts, art shows, labyrinth walks and other such meditative activities and retreats.

By being integrated into the surrounding community, the Centre would diminish the stigma associated with mental illness, making it easier for people within the wider community to access professional mental health services when necessary. It would enable the surrounding community to fulfill a vision it might have of itself as being an open-minded, caring community that exhibits compassion to all its residents.

STAFFING AND VOLUNTEERS

Mental Health Professionals

Support Staff

Assuming 18 clients, the staff requirements and costs are estimated as follows:

Volunteers

PROFESSIONAL SUPPORT FOR THE CENTRE

FINANCING AND BUSINESS CASE

A combination of public and private funds will support the development and ongoing operational costs of the Cottage Farm Centre. As with our current health system, public funding would cover the salaries of the medical and professional mental health staff.

Costs not covered by the medical system would be covered by a combination of client fees and private fundraising.

We estimate that __ of the 18 clients or their families would have the wherewithal to pay $1,000 per month toward the cost of their care at the Centre. The remaining ten would contribute their disability payments of $750 per month to the cost of care, for a total income of....

Additionally, a major fundraising initiative would be required to raise approximately $x million. Of this, approximate $x million would go toward buying land and building the facilities. The remaining $x million would be placed in an endowment fund, the proceeds of which would go toward ongoing support staff salaries and operating costs.

Volunteer expenses? Food? Entertainment? Program costs? Etc. etc.

TIMELINE

THE REQUEST

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