CASRA is an association of not-for-profit agencies that serve Californians that turn to the public mental health system for help. Over the past 40 years, CASRA agencies have pioneered the development of a range of services to divert clients from institutional placements, jails and homelessness and to assist individuals/families to develop the skills and support necessary to lead a meaningful life in their community.
The services offered by CASRA member agencies are based upon the philosophy and principles of social rehabilitation, a person and culture-centered approach that fosters relationships which promote wellness and a positive sense of self. The goal of social rehabilitation is to help people reach and maintain a healthy level of social and vocational success.
Such services include: transitional and permanent supported housing; community residential alternatives to institutional 24-hour treatment; outreach and engagement services; full service partnership services; integrated mental health and substance abuse; wellness centers; advocacy and service coordination and services designed to support education and employment goals.
The 32 member organizations provide services in 28 California counties and serve well over 100,000 adults a year. In a recent survey of 27 member agencies, it was reported that CASRA members represented over $600 million in total budget and over 4,000 staff including over 300 peer specialists.
The philosophy and practice of social rehabilitation grows from the fundamental belief in the capacity of individuals to grow beyond the disabling effects of whatever disability or “dis-ease” troubles them. The goal of social rehabilitation is to create opportunities where the natural human capacity for growth and healing can take place.
Social rehabilitation (SR) is an outgrowth of humanistic psychology. Rather than believing that individuals need to be “cared for,” social rehabilitation emphasizes individuals’ rights to self-determination, choice and collaboration with service providers.
Social rehabilitation services are designed to assist a person with serious mental health issues to self-manage symptoms effectively and to compensate for difficulties associated with the illness and its treatment. Research in the field has demonstrated that persons who receive SR services are significantly less likely to be hospitalized, homeless, or incarcerated and more likely to return to work, school or other productive roles in the community.
The application of SR techniques ranges from alternatives to hospitalization for persons experiencing acute distress to work with people who, while psychologically stable, have become dependent on the mental health system as a life style.
Homelessness – Challenging the Building Narrative
We are deeply concerned about the building narrative that mental illness is the largest contributor to the increase in homelessness. Legislative efforts to expand the grave disability criteria and change LPS conservatorships are a reflection of this simplistic view of a complex social phenomenon. If you believe the reason that people are on the streets is due to them having a mental illness, then your solutions will be focused on mental illness. Although as many as 25 to 30 percent of those living on the streets could be diagnosed as having a mental illness, this doesn’t mean that their mental illness is the reason why they are on the streets. Correlation is not the same as causality. However, should homelessness not be resolved to the satisfaction of voters, someone is going to have to carry the blame. We fear that ultimately it will be the folks who have been labeled with a mental illness who will bear the brunt of society’s frustration. Click here for the full text of an essay by Chad Costello, CASRA President.
Poverty – the Great Disabler: Supporting Economic Self-Sufficiency and Employment
A commitment to assist every interested person with psychiatric disabilities to succeed in the competitive labor market ought to be the cornerstone of recovery-oriented systems and practice. The assumption that people experiencing psychiatric disabilities are unready, unmotivated or unable to work dooms another generation of those experiencing serious mental health challenges to a lifetime of “thwarted ambitions, numbing poverty, and limited community inclusion (Baron, Solomon, Brice and Conners, 2014).
“It is nearly impossible to make your own future when you are not part of the economic fabric of the culture you live in (Deegan, 2004).
The hard reality is that very few people with psychiatric disabilities work in the competitive labor market in spite of their desire to work and the good intentions of government and non-governmental entities, unemployment continues at a staggering 85% despite the identification of a number of evidence-based practices that support achieving competitive employment.
CASRA has developed a concept paper which outlines the key principles and recommendations to move this agenda forward. We are particularly committed to keeping transitional age youth and young adults who are experiencing challenges to their mental health from the disability trap (i.e., cash benefits and life-long poverty).
Toward a Vision of Non-institutionalization – Implementation of Olmstead
Since the passage of the Community Residential Treatment Systems Act (1977), it has been the policy of the state of California to develop alternatives to institutional and custodial care settings. Social model, crisis and transitional residential treatment programs serve individuals who would otherwise be in involuntary, locked inpatient units, psychiatric health facilities and skilled nursing facilities.
The movement towards deinstitutionalization culminated in the 1999 Olmstead v. L.C. decision, in which the Supreme Court asserted that people with disabilities have the right to receive care in the least restrictive setting possible.
However, a 2018 report found that in a review of the cost reports for 22 counties (2009-10), locked institutional care takes up more than 80 percent of all spending on 24-hour care in a majority of counties.
Preserving the Promise of the Rehabilitation Option in Specialty Mental Health Services
In 1993, California amended its State Medicaid Plan to provide services under the rehabilitation option. CASRA saw this move as an opportunity to shift the emphasis of services from traditional medical model, illness-focused care to services that would support recovery, community inclusion and enhanced quality of life. A shift from treating an illness to helping a person.
At that time, many counties had no experience with social rehabilitation services or providers. Over the years the situation has been complicated by massive changes in leadership at both the state and local levels as well as county staffing patterns that remain overly reliant on licensed MH professionals who may be unprepared to practice SR. It is therefore not surprising that we are seeing the interpretation and implementation of state and local policies that are in conflict with recovery-oriented services. This runs counter to the vision expressed in the Mental Health Services Act, and the opportunities offered under California’s specialty mental health waiver. In short, we are caught in a MediCal undertow that is making it very difficult for CASRA agencies to provide recovery-oriented services and that threatens to completely undermine the role of rehabilitation in recovery.
The Role of Social Rehabilitation Professionals in the Behavioral Health Workforce
The majority of community-based rehabilitation services for adults are provided by Mental Health Rehabilitation Specialists (MHRS) who have varying job titles, diverse educations and cultural backgrounds. Organizations spend considerable resources to train staff in SR principles and practice but much of the agencies’ attention has been focused on the increasingly challenging recruitment of licensed staff.
With a severe shortage of licensed practitioners, the only sensible way forward is to expand the use of non-licensed professionals such as MHRS or Certified Psychiatric Rehabilitation Practitioners (CPRPs). This will allow licensed practitioners to perform those tasks for which they are required by statute, regulation and training, maximizing the bene fit of their licensure. This effort will need to be paired with an honest and thorough review of existing positions and job qualifications. There are many positions in non-profit and public behavioral health programs that are currently occupied by a licensed professional more out of habit than necessity. “Just because a licensed person is in a position, does not mean you need a licensed person in that position.” CASRA believes that rehabilitation professionals should provide rehabilitation services.