( copywrite owned by Vicki Fox Wieselthier, 1430 Olive, Suite 500, St. Louis, MO 63103. vickifw@ix.netcom.com Please contact the author for permission to use any portion of this document. Introduction MENTOR: Modeling Excellence Naturally Through Our Recovery The Mental Health Association of Greater St. Louis and the St. Louis Depressive Manic Depressive Association Mentor Program offers St. Louis City residents with serious and persistent mental illnesses opportunities to plan, administer and deliver a comprehensive program of self-help/mutual assistance services which supports recovery while it promotes independence and interdependence. The Mentor Program will serve as an adjunct to professional treatment and will be part of the integrated services system available to St. Louisans affected by mental illness. Objectives: * Reduce demands made on traditional providers of mental health services for services that can effectively and appropriately be delivered by a self-help mutual/assistance program without duplicating or competing with existing programs; * Outreach all segments of the St. Louis City community of persons with serious and persistent mental illness who would benefit from self-help/mutual assistance with a special concentration on people who are unserved or underserved by existing programs because of the limitations placed upon them by funders; * Engage people with mental illness and people who are dually diagnosed with mental illness and alcohol or drug abuse (MI/ADA) in self-help/mutual assistance activities which are accessible and culturally competent; * Become part of the integrated "no wrong door" service delivery system, so that consumers of mental health services will be able to access, through the Mentor Program, both consumer delivered self-help services and existing professional services in a manner they find acceptable, welcome and comfortable; * Provide a wealth of opportunities for people to participate in self-help/mutual assistance so that they may choose the degree of involvement and the approach which they find most helpful and supportive of recovery; * Reduce social isolation and improve social skills through self-help/mutual assistance activities both in the community and at a City Self-Help Center (the Mentor Center) which is designed, directed and operated by consumers; * Model competence, recovery and sobriety through exposure to consumer leaders who are themselves competent, healthy, and sober; * Reduce the stigma of mental illness within the community, the family and within the hearts and minds of consumers themselves who often internalize the stigma and convert it into self-hatred and loathing; * Demonstrate the benefits of self-help/mutual assistance for persons with persistent mental illnesses through the measurement of qualitative and quantitative positive outcomes which may include reduced isolation, improved relationships with family and friends, an increased willingness to accept professional services, decreased reliance on professional assistance for social support, and increased participation in community life including education, recreation and employment. * Provide opportunities for mental health consumers to develop the knowledge base and experience to advocate effectively for the political and economic policies and mental health treatment which they identify as being most beneficial and in their own best interests. The Mentor Program has four components. They are the Mentor Center, the Mentor Friendship Line, Community Based Self-Help Groups, and Individual Peer Support. It is a comprehensive, and complicated, undertaking which may take almost two years to fully implement. The budget pages and utilization estimates included in this application reflect the program's expected status when the full program is operational. The explanation of all four program components can be found within the Program Description section of this application. Overview of Need Prevalence The National Institute of Mental Health has estimated the prevalence of mental illnesses and mental disorders to be approximately 15% of the total population. The Epidemiological Service Area studies, conducted in rural, suburban and urban areas of St. Louis, New Haven, and Baltimore, indicate a prevalence of 19-20% of the population will be experiencing a mental disorder at any one point in time. Using both studies, with a limit of 19%, St. Louis City with a population of 396,685 has approximately 75,370 residents suffering from a mental illness or mental disorder at any one point in time. The Missouri Department of Mental Health, in its PLAN UPDATE, and other literature, states that only 15-20% of individuals with recognized mental disorders receive public and private treatment. The State of Missouri, according to its mandated State Mental Health Plan, seeks to serve 2.3% of the population. The 1995 Community Mental Health Services Plan For Adults states that in Service Areas 24 and 25 which comprise the City of St. Louis that 11,633 adults have a severe diagnosis while an additional 5,062 adults have severe and chronic diagnoses. Extrapolating from these estimates, the Mentor Program will have, in St. Louis City, a base of up to 16,695 individuals. St. Louis City is critically underserved at this time. Current Service System Missouri has a centralized public mental health administrative structure. The state is divided into 25 service areas, ranging in population from under 100,000 to close to one million (St. Louis County). St. Louis City includes Services Area 24, for which Hopewell Mental Health Center is the Administrative Agent, and Service Area 25, for which St. Louis Mental Health Center is the Administrative Agent. Both have provided letters of support for the Mentor Program. Both centers deliver or contract for mental health services including casemanagement, community support, medication services, outpatient psychiatry, counseling, crisis service, and psychosocial rehabilitation. Both are Community Psychiatric Rehabilitation Centers (CPRC) and deliver Medicaid funded CPRC services to people meeting income, diagnostic and other limiting criteria. Both also serve AFDC families by providing Medicaid managed care psychiatric services through the MC+ program. There are no self help/mutual assistance components in any of these programs. There are no drop-in centers in the City, with the exception of St. Patrick Center's Shamrock Club. The Shamrock Club is open only to persons who are homeless. People who qualify diagnostically and who receive the appropriate funding may choose from several well run, effective psychosocial rehabilitation programs designed, directed and run by caring, well trained mental health professionals. In the City of St. Louis these programs are Independence Center's West Pine House, Places for People, Hopewell Center, and the Adapt Gateway Soulard Club. Prevocational training, employment assistance and psychoeducational programs are available at these locations. City consumers also attend the Self-Help Center in Kirkwood. Attendance at the city programs is already measured in units of service and continued attendance is often linked to the pursuit of staff defined treatment goals. As good as these programs are, they do not meet the needs of everyone who would benefit from opportunities to organize their time more productively or participate in structured group activities. This is especially important as we move into a managed care environment which limits access to services as a cost saving strategy. The Department of Mental Health has already limited the number of hours of attendance a psychosocial rehabilitation provider can be paid for. Recently, a significant portion of the Medicaid population has recently come under a managed care contract through the implementation of the MC+ program. People who exhaust benefits from this program may very well not qualify for additional service through existing programs. As we move into a managed care environment, opportunities to attend psychosocial programs may become even more time limited and subject to defined benefit maximums. Until mid-April 1995, the Independence Center accepted persons without funding into the Clubhouse Program. Due to a change in the interpretation of Medicare rules, this policy has, at least temporarily, been abandoned. People who do qualify for Independence Center attendance go through a thorough and exhaustive intake process that delays their participation by several weeks as medical records are obtained. All of the psychosocial service providers in the city have provided letters of support for the Mentor Program. Vocational services for City residents with psychiatric disabilities are provided by a number of different organizations. Independence Center's Transitional and Assisted Competitive Employment Programs have won national recognition. Independence Center serves as a national training base for these employment services. St. Patrick Center offers a comprehensive employment program including food service training at McMurphy's Grill. The Division of Vocational Rehabilitation (DVR), through its contract providers, arranges for educational assistance, prevocational testing, work adjustment training, job coaching, and other employment related services. St. Louis Mental Health Center, Places for People, Goodwill Industries, and others also provide employment services. The Mentor Program has chosen not to incorporate its own employment program into its design. We believe that in these days of scarce resources it makes little sense to create a program that duplicates services already available in the community. Instead, it is our intention to make the existing programs more effective for consumers by providing assistance accessing existing programs, advocacy for people experiencing difficulties in existing programs, and peer support to those who are receiving professionally delivered vocational assistance. MERS (Metropolitan Employment & Rehabilitation Services) has held several meetings with DMDA to discuss the formation of a support group tailored to the needs of people with mental illness in its various DVR funded training programs. The Future of Service Delivery The mental health system is undergoing rapid change not only in St. Louis, but nationwide. As health care has become increasingly expensive, it has moved to center stage as a national priority. As we attempt to reduce the federal budget deficit and balance the budget, the programs that provide mental health care and the wrap around supports that assist people with mental illness have come under increased scrutiny. Some examples of challenges to the current system follow. The Center for Mental Health Services has made available funding for outreach and engagement services for people who are homeless and mentally ill through Programs to Aid in the Transition from Homelessness (PATH). In St. Louis, PATH money is used to fund the St. Patrick street outreach program, the homeless drop-in center, Harbor Light shelter services, and the St. Louis Mental Health Center shelter outreach service (SOS). Senate Bill S. 1594 would cut PATH money by 33%, greatly threatening the continued existence of these programs. Missouri, like many other states, has devoted very little of its own money to these essential services. The pick-up for these programs would have to come either from an increase in state general revenue funding or by a reallocation of money from the Missouri Mental Health Block Grant, which is itself facing a 28% cut. Other services important to people with mental illness affected by this legislation include the FEMA Emergency Food and Shelter Program which provides utility assistance, rental deposits, and transitional housing to people with mental illness and others. The 23% cut this program faces would be devastating to homeless prevention efforts in St. Louis. The HUD Homeless Assistance programs (Emergency Shelter Grants, Supportive Housing, Shelter Plus Care, Section 7 SRO Moderate Rehabilitation) will be cut 27% under this bill. The Shelter Plus Care program which provides housing for mental health consumers that is then matched by community providers with equal dollar amounts of supportive services has been a major strategy for providing both housing and services to people with mental illness in the St. Louis area. Programs which are not being eliminated or experiencing funding cuts are also changing in this new environment. For example, the CPRC program has provided a wide variety of helpful services to people with serious mental illness in St. Louis for the past five years. Funding has been a mixture of state dollars which are then matched at a 60/40 ratio by federal dollars. The money available through the CPRC program has lead to the DMH policy of supported housing in the community as an alternative to institutional living. The rules and regulations effecting this program are changing. While, in the past, people who needed intensive long term supports could receive them, the new CPRC policy limits community support services to a maximum of four hours a day and 24 hours a month per individual. This follows on the heels of the decision to limit the availability of psychosocial rehabilitation services available through the CPRC program. If we are to continue to provide the supports needed to help people continue to live successfully in the community, we will have to come up with either more state money from general revenue or alternative service delivery models. A federal decision to block grant all Medicaid programs would undoubtedly limit these services even more. In September, St. Louis area AFDC families became the first Missouri recipients of public assistance to have their medical coverage delivered in a managed care environment. The MC+ program was designed with limited input from the Department of Mental Health and has very limited mental health benefits. Although people with permanent and total disability (PTD) are not yet under managed care, this too is coming. We can expect that services to people with mental illness will be reduced when this happens as managed care companies nationwide have not valued systems of care that support the needs of people with serious mental illness. Although managed care is supposed to result in services that are both efficient and effective, they have yet to identify the outcomes by which mental health services will be judged. The Role of Self/Help Mutual Assistance This is a good time to do self-help/mutual assistance. The changing funding environment facing professionally delivered services challenges existing providers to meet even the most basic of needs. Mental Health providers will have to work together with the providers of generic supports available to poor people and non-traditional providers of service if they hope to make a real difference in the lives of people they serve. Self-help/mutual assistance programs which identify gaps in the services array and design programs that fill those gaps will be increasingly important in this new environment. Self-help/mutual assistance programs which actively seek to advocate for client rights in the new system and empower people to become fully integrated into the life of their communities will be essential. It has only been eight years since the National Institute of Mental Health first offered demonstration grants to fund consumer focused, consumer run programs and agencies. People who received those grants were largely on their own. Consumer leaders nationwide solved the problems they experienced by meeting together monthly via conference calls to share their skills and expertise. Individual centers that experienced success like Project SHARE in Philadelphia, the Ruby Rogers Center in Boston and the Berkeley Drop-in Center in California were inundated with requests for how-to hints and technical assistance. Much of the learning was done by trial and error. And there were many errors. We know how to do self-help/mutual assistance now. There is a growing body of literature about successful comprehensive self-help/mutual assistance programs. Techniques and skills that work are established and well known. There are two consumer run technical assistance centers funded by the Center for Mental Health Services which provide training and assistance to organizations operating consumer run, consumer focused programs. Several DMDA Board members have close working relationships with senior management personnel at these two centers. Although the idea of a comprehensive system of self-help/mutual assistance is new to St. Louis, it is a tried and true concept. About ten years ago, the Mental Health Association (MHA) of Southeastern Pennsylvania launched PROJECT SHARE (Self-Help and Advocacy Research Exchange). Today SHARE is far larger than the MHA and, while it operates more or less independently from the MHA, the two organizations continue to have a close and synergistic relationship. Three years ago, SHARE successfully sought to become one of the two Technical Assistance Centers. SHARE training materials will be used extensively in the Mentor Program. Some of the estimates of consumer utilization of the Mentor Center came from published reports on Peer Run Drop-In Centers SHARE has assisted on the east coast. SHARE has proven to be very attractive to foundations and government funders. We expect that, once established, the Mentor Program will also be able to attract funding from diverse sources. We are fortunate that the Philadelphia MHA and SHARE have had such extensive long term success working together. It is expected that we will rely heavily on their technical assistance to guide our two organizations as we reach for similar success. We are aware that the blending of two separate programs can lead to conflicts. Our memorandum of understanding, which can be found in the Appendix to this application, provides a mechanism for conflict resolution should that occur. Solomon, Gordon and Davis, in their study of psychiatric re-admissions, identify the availability and utilization of community based services "to have a significant influence in differentiating re-admissions from non-re-admissions." They go on to note that, "Those discharged patients who received a greater variety of aftercare services and had a greater degree of their service needs met were less likely to be re-admitted."1 The significance of these two variables demonstrates the importance of viewing people with ongoing mental illness as having multiple needs. NIMH has recognized this concept in its design of the Community Support Program. The structure and services of the DMDA/MHA Mentor Program, as shown in the remainder of this application, further consumer empowerment. As Paster points out, appropriate programs for difficult to reach (mental health) populations should be "...attractive and readily accessible, ...should mobilize the strengths of the participants and produce beneficial and long lasting changes that lead to other positive effects on the lives of the participants."2 Further, Paster cites Hollister, et al's principles of effective parsimony3 which state that, "the care offered should cause the least disruption in the recipient's life, should be provided locally..., and should be the least intensive, the less extensive and the least expensive required for results."4 The Mentor Program Partnership Background and Introduction The Mentor Program is a joint application of the Mental Health Association of Greater St. Louis (MHA) and the St. Louis Depressive and Manic Depressive Association (DMDA). When this round of funding was announced, both organizations prepared proposals for a self-help program featuring a drop-in center (as did the proposal submitted by the Comprehensive Self-Help Center in Kirkwood). The Alliance for the Mentally Ill (AMI) submitted a proposal for a family outreach program targeted to expanding family support services to the minority community. At the urging of the Mental Health Board of the City of St. Louis, all four organizations explored the possibility of submitting a joint proposal which would build on their individual strengths and overcome their individual weaknesses. Early in the process AMI indicated that it would co-locate with whichever self-help proposal was funded leaving the other three organizations with the difficult task of deciding which, if any, of them could work well together and create a comprehensive self-help/mutual assistance program for residents of the City of St. Louis. Both DMDA and MHA analyzed the situation in a similar fashion. Both organizations realized that for a joint venture to succeed the organizations involved would have to share both their values and their vision. Both organizations also knew that they would have to be able to communicate openly and honestly with each other. After a series of discussions, DMDA and MHA decided that they had a great deal in common philosophically and that their vision of self-help and the unmet needs of people with mental illness living in St. Louis were the same. The leadership of the two organizations have worked together on other projects in the past and respect and trust each other. In fact, the organizations had, in the past, shared program space. Beyond that, both organizations understand and value each other's strengths and feel that together they can operate a program that would be much stronger than either of the programs they had submitted separately. The strengths that MHA brings to the joint proposal are: * Program space in their building at 1905 South Grand and sufficient funding to renovate the space required for a drop-in center; * Established business procedures and financial systems; * A solid financial base with over $600,000 in assets; * A Board of Directors with important ties to the business and financial community and the media; * Their status as a United Way agency. DMDA brings the following strengths to the joint proposal: * Fifteen years experience operating self-help groups in St. Louis; * A knowledgeable and active Board of Directors with 50% consumer members; * Leadership with extensive knowledge and respect in the national consumer/survivor community; * Concrete offers of training and other in-kind support from both administrative agents and virtually every provider of mental health services in the St. Louis area; * Significant financial support ($40,000) from the Department of Mental Health for this proposal. Both organizations identified core values including: * A commitment to develop programming that was culturally competent and would be acceptable to a diverse population of mental health consumers; * A belief that a self-help organization should not duplicate services already found within the professional community; * An expectation that an effective self-help program be consumer run and consumer directed and that all key personnel would be mental health consumers; * An awareness of the importance of interdependence as a strategy for meeting the challenges facing service provision in today's political and healthcare environment and a strong resolve to work closely and harmoniously with other organizations; * An understanding that there is a large unmet need for a safe and health promoting environment that is welcoming to people who are not currently engaged in mental health services because they have either fallen through the cracks or have not had their needs adequately addressed by existing providers. St. Louis Depressive and Manic Depressive Association Full implementation of the Mentor Program will transform DMDA, a small but very effective consumer focused and consumer run not-for-profit agency whose only "product" is community based self-help groups and education about mental illness into a comprehensive self-help/mutual assistance program. The association's long term planning committee met together every two weeks for over six months to prepare the organization for the growth and shift in focus that the Mentor Program would bring about. We have strengthened our board of directors by adding additional mental health consumers who have extensive experience and training in self-help/mutual assistance. They currently work professionally as mental health researchers, university faculty, and advocates. This grant application was prepared by one of these individuals. We have explored with our membership, our group leaders and the full board every aspect of the challenges of expansion. We know that small specialized organizations like ours that operate on a limited budget without the benefit of an Executive Director or staff with highly specialized skills will probably not survive in the new world of managed care and health care consolidation. We are ready to meet the challenges of the new health care environment. We will do this by partnering with the Mental Health Association and other existing programs in ways that increase our efficiency, develop our business acumen and skills, and make our self-help programs a valuable addition to the continuum of services available to men and women with mental illnesses who reside in the City of St. Louis. Our fourteen trained volunteer group leaders are the heart and soul of DMDA. All but one of these are primary consumers. The fourteenth group leader is a family member. Delores Segal, our founder, is still active as a group leader and organizes our annual seminar. Our group leaders facilitate over forty community based self help meetings a month. Volunteers serve in our office two days a week allowing it to remain open even when there is no paid staff. We currently employ volunteers as our Director of Outreach and our Director of Publications and Development. Both of these volunteers are primary consumers. Mental health professionals volunteer their services to the community based self help groups. Most of the groups have a physician or other mental health professional in attendance once a month. Our physician volunteers also contribute articles to our quarterly newsletter, provide group leader training and are available to the group leaders as needed when professional assistance is needed. Group leaders each volunteer, on average, ten hours a month. The DMDA Board of Directors is a working board. Board members volunteer their considerable expertise to the organization willingly and to great effect. In 1995 Board members contributed over 900 hours of their time to the association. All members of the Board also contribute financially. It is entirely due to the hands-on activity of our Board members that DMDA has been able to survive without the services of a paid executive director. When this activist board decided that the organization would seek an opportunity to expand our self-help/mutual assistance services, it fell to the Board to develop the vision which would carry DMDA into the future as a major provider of assistance to people with serious mental illnesses. Over half of the Board members are primary consumers of mental health services. The remainder of the Board members are mental health professionals, family members, and persons with a special interest in assisting our organization from the community at-large. The Mentor Program will provide special challenges to our volunteers, in particular to the group leaders. Although no-one has ever been turned away from a DMDA-St. Louis support group meeting because they had the "wrong" diagnosis, our group leaders will have to become more familiar with the other mental illnesses. Fortunately we have been able to attract promises of training from experienced and dedicated professionals including the President of the Eastern Missouri Psychiatric Society. Our letters of support include commitments to provide significant amounts of training to our volunteers and paid staff. DMDA currently operates support groups at thirteen different locations in the greater St. Louis area including three in the City of St. Louis. Our annual mental health symposium is well attended by consumers, family members, and mental health professionals. We have developed, during our fifteen years of existence, an extensive reference library which is overseen by a mental health consumer with a degree in library science and many years experience as a university librarian. We produce and distribute a consumer edited quarterly newsletter with a circulation of 2000. Visionquest, a chapter of the Missouri Mental Health Consumer Network, meets in the DMDA office and uses its computers and library. DMDA receives approximately 80 requests a month for information about mental illness, advocacy assistance, and referral to support groups. DMDA staff and volunteers assist consumers applying for social security disability and other entitlements and maintain a referral list of mental health professionals. Consumers are welcome to use the DMDA computer funded by the Mental Health Board to write resumes, improve their computer literacy, and produce advocacy materials. This year some consumers used the MHB computer (M.I.K.E.) to prepare their tax returns. The Mental Health Association of Greater St. Louis The Mental Health Association of Greater St. Louis was founded as the St. Louis Mental Hygiene Society in 1947. The mission of the Association is: 1) Work for the promotion of mental health; 2) Work for the prevention of mental illness; and 3) Work for the improvement of the care and treatment of the mentally ill. The Association is a United Way Agency and has a stable funding base. With assets of over $600,000, the Association can present a secure program to the St. Louis community. Although the Mental Health Association currently does not provide treatment services, MHA's throughout the country have done so successfully either on their own or in partnership with others. Over the years, our long time supporters, including members of our Board of Directors, have urged us to identify an area of direct service provision that would be consistent with our mission and values and which would expand upon, rather than compete with, services already available in the St. Louis area. We believe that the Mentor Program will be very attractive to corporate funders in the St. Louis area with whom the Mental Health Association already has proven long term relationships. The Association has access to corporate board rooms and the media which should prove invaluable to any organization which hopes to attract a broad funding base and garner the respect and attention of the St. Louis community. The Association currently provides sixteen programs in four broad areas. They are volunteer patient services, professional education, public education and community services. Many of these programs can be improved upon by the addition of a consumer perspective. For example, we currently offer a Shelter Workers educational series four times a year. Adding the voices of mental health consumers who have themselves resided in shelters would be a valuable addition to this program. The Association has also assumed the leadership of the coalition which develops the programming for Mental Health Month. Although this coalition has been responsible for promoting increased awareness of mental health issues and has sponsored wonderful educational programs, it would be extremely valuable to have a group of mental health consumers on site involved in the planning of Mental Health Month. Many of the programs the Association currently operates dovetail with proposed programming for the Mentor Program. We are especially excited about the possibility for expansion of the Compeer Program and recognize that the extensive training provided to Compeer volunteers will be valuable to the Individual Peer Support Workers envisioned in this proposal. The Self-Help referral service currently operated by the Association will be greatly improved when paired with the Mentor Friendship Line. The Mental Health Association Board of Directors is composed largely of community and business leaders. All Board members contribute financially to the organization. The Board is able to offer the Mentor Program a broad understanding of the St. Louis community and its needs. It is also able to rally the support and assistance of the most influential individuals and organizations in the St. Louis area. Over the years the MHA has been able to count on considerable volunteer support and assistance. MHA volunteers will play an important role in the Mentor Program. Our Location The Mental Health Association Board of Directors, at its November, 1995 meeting, pledged to renovate its lower level making it handicapped accessible and available for use as a self-help center. The cost of the renovation and equipment purchased outside the scope of this grant will be approximately $70,000. When renovated, the lower level will offer approximately 2500 square feet of attractive, modern, and welcoming program space. Mentor Program participants will be able to use other parts of the building as needed. Both DMDA and MHA realize that it is possible that the program could, in time, outgrow the space available to it at 1905 South Grand. Should this happen, we will work together to purchase a larger site. The Association recently improved the lighting in its parking lot making the building safer at night and more useful to the Mentor Program which intends to offer evening hours. Copies of the architectural plans for the renovation can be found in the Appendix. We encourage the Mental Health Board to come view the space planned for renovation. The Mental Health Association of Greater St. Louis is located at 1905 South Grand Boulevard in the City of St. Louis, one block south of I-44. Both of these thoroughfares are distinguished by the service and scheduling provided them by the Bi-State Transit System, St. Louis City and County's bus system. The location is served by the Grand Avenue bus line, the Tower Grove line, and the 80 South Hampton line. These three lines provide service to areas as diverse as St. Louis Hills and the Ville Neighborhood. Connections to these lines serve all of St. Louis City. The Grand Boulevard bus runs north and south approximately every 15 to 20 minutes during peak hours. The other busses run less frequently. Connections to the Metro system can be made from the Grand bus line. Our South Grand location places us within the most racially and economically integrated area in the St. Louis community. We are convenient to the 8th, 17th and 4th wards, all of whom have had a diverse population for many years. We are also located in the area of the City that has become most attractive to St. Louis's growing immigrant/refugee population. Our building is across the street from Reservoir Park which has picnic areas and tennis courts. We are two blocks away from the Southside YMCA and a short walking distance from a National Supermarket. Also nearby are Tower Grove Park, Mullanphy Community School, Missouri Botanical Gardens, two St. Louis libraries, and the St. Louis University medical campus. The relatively low rents in the surrounding area have made this an attractive location for mental health consumers living in the community. Because both MHA and DMDA are bringing their own programs and resources together, including extremely valuable program space, we will be able to offer some Mentor Program services to people who live outside of the City. For example, the staff and resources currently allocated to the MHA Self-Help Referral Program and DMDA office staff and volunteers make it possible to open up the Friendship Line to callers who reside in the greater St. Louis area. The financial support from DMH also expands our ability to meet the Self-Help needs of the greater St. Louis area. The two organizations are already seeking additional funding for the Mentor Program from United Way and the Community Foundation. Operational Outline The Mentor Program will be jointly operated by both organizations. We initially considered having DMDA operate some program components and MHA operate others, however, as our negotiations continued it became increasingly clear that this would create unnecessary complications. For example, although we decided that DMDA would have operational control of personnel and program development, we initially designated some staff as MHA employees. When we compared personnel policies we discovered that they were substantially different. We also recognized that neither organization was satisfied with their current policies. Our solution was to have the MHA Board appoint a personnel policy committee which would have DMDA representation to develop a new personnel policy that would govern MHA, DMDA, and the jointly operated program. Until such time as the new policy takes effect, employees will be under the MHA Personnel Policy as they currently have many more program staff. Hiring and supervision of the Mentor Program Director, who will initially also serve as the DMDA executive director, will rest with DMDA. A search committee which will include MHA representation will be established. Additional staff will be hired by the Program Director with DMDA Board assistance and consultation. MHA has strong fiscal policies and established bookkeeping and accounting systems. Although financial arrangements cannot be made without the approval and guidance of the Mental Health Board of Trustees, it is our thought that money for the Mentor Program will be paid into a joint MHA/DMDA account and dispersed over signatures from both organizations. The program itself will have a petty cash account. MHA will oversee all bookkeeping, audit, and payroll functions including the reconciliation and monitoring of petty cash. Funds from MHA, DMDA, and the Mentor Program will not be commingled and the Mentor Program will be separately audited. The executive director of MHA will provide financial oversight to the Mentor Program. MHA will also allocate 10% of an existing staff development specialist to Mentor to locate additional funding sources and assist in grant preparation. All publications and promotional materials will list both MHA and DMDA as program sponsors. Application for additional Mentor Program funding will be made jointly whenever possible. To that end MHA will do everything in its power to assist DMDA in its efforts to become a more financially viable program. The two organizations will jointly appoint and participate in a Community Advisory Board. Both administrative agents have already agreed to be represented on this Board. Mentor Program personnel will staff the Board. This Board's primary responsibility will be in overseeing the Mentor Program's relationship with the professional community and its general community involvement. The Board will also review program outcomes, utilization, and quality improvement efforts. The Board's of Directors of both organization will receive regular program updates. It will be the responsibility of the Program Director to insure that Mentor Program advocacy efforts and public statements are respectful, well thought out and in keeping with policies and positions that can be supported by both DMDA and MHA. Both DMDA and MHA will make available to the Program Director extensive consultation regarding areas of potential conflict. As noted above, DMDA will have the ultimate responsibility of supervising the Program Director. Conflict resolution between the two organizations will, in general, be handled internally by representatives of the two bodies. Should conflicts develop that cannot be easily resolved, we hope to be able to use Mental Health Board staff as mediators. The Memorandum of Understanding of the two organizations will be expanded upon once funding is awarded. Community Partnerships Introduction to Community Partnerships We have promises of assistance and support from the Department of Mental Health, both Community Mental Health Centers, the National Empowerment Center, MIMH, and many other St. Louis organizations and service providers. Letters of support and in-kind donations received from these community partners can be found in the application attachments on file with the Mental Health Board. Combined with our own expertise in self-help/mutual assistance, this assistance and support will make the DMDA Mentor Program's comprehensive self-help/mutual assistance services a reality for people in St. Louis whose lives are affected by mental illness or mental illness and substance abuse. The St. Louis professional community has a long history of supporting the activities of the Depressive and Manic Depressive Association of St. Louis and the Mental Health Association of Greater St. Louis. Each of the existing DMDA groups receives the assistance of mental health professionals. Most groups have a psychiatrist in attendance monthly while other DMDA St. Louis groups rely on the expertise of psychiatric social workers and pharmacologists. Three psychiatrists, all with university affiliations, sit on the DMDA Board of Directors. Both of the executive directors of the agencies which are also DMH Administrative Agents have agreed to participate in the Community Advisory Board DMDA and MHA will establish to provide input into the program. Both Hopewell Center and St. Louis Mental Health Center have been involved in and supportive of the submission of this application. Hopewell Center's King Fanon program has an established relationship with the Mental Health Association. Hopewell staff have provided leadership and assistance to many of the MHA training programs. The following table summarizes the support offered by the professional organizations we view as our community partners:5 Adapt Institute Jack Hilliard Adapt has promised 24 hours a year of program development consultation African American Churches Task Team Rev. Brenda Hayes The AACTT will provide eight hours a year of cultural diversity training to group leaders Alliance for the Mentally Ill Richard Stevenson The Alliance's minority outreach program will operate out of the MHA building at 1905 South Grand. Barnes Hospital Bette Leventhal Barnes will provide eight hours of training per year by psychiatric nurses regarding medication issues and medication compliance Barnes Hospital Chemical Dependency Unit Cathy Meyers, MSW Barnes Chemical Dependency Program will provide four hours per year of inservice training Behavioral Health Response Sandy Diamond BHR will provide training to Friendship Line workers. City of St. Louis, Department of Health and Hospitals Bill Dotson Mr. Dotson will provide four hours of training in the area of outreach to the African American population and cultural sensitivity Department of Mental Health Robert Muether The DMH will provide two kinds of financial assistance. It has agreed to pay for $20,000 of capital expenses associated with start-up and it will pick up over $20,000 in operating expenses dedicated to the Individual Peer Support component. Eastern Missouri Psychiatric Society Dr. Elizabeth Pribor EMPS will provide 8 hours of training per year Effort for AIDS Michael Curren EFA will provide AIDS-HIV education for Program Assistants and participants. Hopewell Center Dr. Amanda Murphy Hopewell will help us recruit paid staff, program assistants, and volunteers. Dr. Murphy has agreed to sit on our community advisory board. Independence Center Robert Harvey Independence Center will provide 200 hours of training for group leaders, staff, and program participants. This will be in the form of a one week intensive training course at West Pine House. Independence Center is a national training base for the Clubhouse Model of Psychosocial rehabilitation. Life Crisis Services Lee Judy Life Crisis will provide training to Program Assistants staffing the Mentor Friendship Line Missouri Institute of Mental Health (MIMH) Dr. Danny Wedding The Missouri Institute of Mental Health is providing an additional $20,000 of in-kind program evaluation assistance and will assist us in our attempts to diversify our funding base. National Empowerment Center Bob Bureau NEC will provide technical assistance and access to their Internet resources Paraquad Gray Kerrick Paraquad will provide training relevant to the Independent Living Philosophy, including ADA information. Places for People Francie Brodereick Places will do reciprocal training with staff SLU School of Social Service Maria Bartlett, Ph.D, Cathryne L. Schmitz, Ph.D. SLU will provide various kinds of training to staff. They would also like to be able to use the Mentor Center as a practicum site. St. Louis Mental Health Center Diane McFarland SLMHC will provide technical assistance and training to the Mentor Program and has offered to allow DMH to reallocate money from its budget to support activities of the Mentor Center. St. Louis Public School system Angeline Hayes The school system will assist in the training of volunteers and staff with regard to outreach in the schools. Washington University School of Medicine Dr. Barbara Geller WUMS will provide $5000 in training regarding childhood onset mental illness. MIMH The Missouri Institute of Mental Health (MIMH). will oversee the development of a Management Information System (MIS) which is conducive to pooling and sharing information regarding outcomes and performance objectives with existing service providers. MIMH research staff will work with the Mentor Program to develop valid and reliable outcome measurements for the program. The MIMH grant writer will work with us to identify funding opportunities. We anticipate using a modular MIS program in use state wide by agencies which serve Department of Mental Health clients called CMIS. Developed by MIMH a number of years ago, this sophisticated program makes it possible to collect demographic, clinical, and satisfaction data in an organized and coherent way. MIMH has agreed to develop a CMIS self-help module specific to the Mentor Center program. Dr. Jean Campbell, who sits on our Board of Directors and is both an MIMH researcher and a member of the University of Missouri faculty, will take the lead in this system development. Dr. Campbell was the lead researcher on the nationally acclaimed California Well Being Project which developed innovative consumer focused instruments to monitor quality of life and satisfaction outcomes. Dr. Campbell has written a short description of the principles explaining her research methodology. It can be found within the Quality Development and Evaluation section of the grant. MIMH will assist with the implementation of our marketing plan by collaborating with us to provide education regarding self-help and the consumer empowerment model both to providers and St. Louis residents who might benefit from our services. The St. Louis Alliance for the Mentally Ill The Alliance for the Mentally Ill has decided to strengthen their activities in the City. Their Director, Richard Stevenson, has approached DMDA and MHA with an interest in co-locating their outreach efforts with us. While the organizations realize that there are differences in philosophy and mission, the need to develop self-help/mutual assistance programs for people with mental illness and their families makes an attempt to bridge those differences and work together worth the effort. In particular, we are planning on coordinating our attempts to provide educational programs and to develop additional self-help groups. This is an especially exciting prospect for us. We will market some of our services together as part of our joint outreach activities. We will co-sponsor educational events, speakers, social functions and we will share resource materials. There has always been an overlap in membership of MHA, DMDA and the Alliance. The DMDA-Alliance relationship is greatly strengthened by the presence on the DMDA Board of Directors of one of the Alliance's most active volunteers, Kay Rittenhouse, Ed.D. Dr. Rittenhouse has been trained as a Journey of Hope leader and has a great deal to offer all three organizations. Leadership within the organizations have worked together informally over an extensive period of time. We are very pleased that the Alliance has chosen to co-locate with us and look forward to this new stage in our relationship. The Comprehensive Self-Help Center in Kirkwood Over time we hope to develop a comfortable working relationship with this organization. It is unfortunate that we have been unable to find a way to work with them throughout this granting process. Eventually, we would like to be able to plan joint social and educational programs with them. We could also realize some cost efficiencies by sharing expenses related to staff training. Although there are significant differences both in style and substance between the two programs, there is room for both within the greater St. Louis community. The Department of Mental Health The Department of Mental Health (DMH) has expressed a serious interest in and support for the Mentor Center. DMDA has enjoyed a close relationship with DMH for a number of years and has had ad hoc representation on the Comprehensive Psychiatric Services State Advisory Council (SAC) for the past six years. Two DMDA Board members currently sit on the Eastern Regional Advisory Council (RAC). The DMH Regional Consultant, Gloria Johnson, MSW, recently became a member of the DMDA Board of Directors. DMDA is currently located on the grounds of St. Louis State Hospital and has established a good relationship with the staff and administration of both SLSH and Malcolm Bliss Mental Health Center. The Executive Director of the MHA is currently the President of the RAC and the DMDA Board President is its Advocacy Chair. Department staff are involved with the MHA Mental Health Month Committees. The MHA has testified on various legislative matters at the Department's request. DMH will provide critical assistance to the Mentor Center. The Department has agreed to pay for nearly all of the equipment and furnishings associated with start-up. In addition to this one time monetary award of $20,000, the Department will negotiate a purchase of service agreement with the Mentor Program to provide on-going support for the program. Currently the DMH commitment will pay for two Individual Peer Support workers. The Self-Help Center in Kirkwood currently receives significant financial support from DMH We expect that over time we will receive a comparable level of support for self-help services provided to City residents through the Mentor Program. DMH will also provide considerable assistance in our marketing effort. The Office of Public Affairs will include announcements and news items regarding the Mentor Program in DMH publications. DMH will continue to provide printing of brochures, newsletters, and training materials "at wholesale" as they do for other not-for-profit organizations. We will be using DMH resources and contacts in developing our public relations materials. St. Louis Mental Health Center and Hopewell Center, the DMH administrative agents operating in the City, will provide assistance to the Mentor Program. Both of them have advocated for us with the DMH Regional Office to obtain Departmental funding. Dr. Amanda Murphy, the Executive Director of Hopewell Center, has indicated a special interest in working closely with the Mentor Program to provide services to mentally ill parents as they learn the skills which will help them keep their families intact. Dr. Murphy has also indicated a willingness to assist us in setting up a support group for children whose parents have a mental illness. Diane McFarland, the Executive Director of St. Louis Mental Health Center, is providing direct financial assistance by allowing a portion of her DMH allocation to be redirected to the Mentor Program in the same way that Great Rivers Mental Health Services has funded the Comprehensive Self-Help Center in Kirkwood. Her staff will be working closely with Mentor Program staff as this project develops. Program Description The Mentor Center (Peer Run Drop-In Center) The Mentor Center will be a Peer Run Drop-In Center. It will operate seven days a week, 365 days a year. The Mentor Center is not intended to duplicate or replace professionally run psychosocial rehabilitation programs. Instead, the Mentor Center will provide an option to consumers who are unable to attend these existing centers because of the limitations on participation placed on these agencies by funders. The Mentor Center will be the only drop-in center in the city available to mentally ill people who are not homeless. The Mentor Center will provide opportunities for consumers to create an empowering, non-hierarchical environment of their own design in which self-help/mutual assistance flourishes. Consumers develop skills and competencies through exposure to their peers. Support groups and educational programs are formed in response to the needs of those in attendance. Leadership skills develop because of the need for leadership. Decision making is participatory and rules and standards of behavior are self-imposed and self-enforced. Peer Drop-In Centers are clean, safe, alcohol and drug free, and intolerant of intolerance because consumers want them that way. Paid staff will have the necessary training and skills to aid in the development of behavioral norms and expectations which promote and insure these essential program characteristics. There is no "right way" to use a Peer Run Drop-In Center. Some consumers may want companionship and the opportunity to enjoy a cup of coffee, or participate in group recreation.. Still others may use on-site resource materials to locate food pantries or a new apartment. There will be people using the computer equipment to develop a resume, write a letter, or learn a new software application. Some people will attend every day and others will come by when they are bored, lonely, or in crisis or when they have worn out their welcome at another program ( or White Castle. Learning and growth occur because people choose to participate in activities which foster these outcomes. People move on because they are ready and they want to ( not because their benefits are exhausted. We hope that the Mentor Center will be accepted and used by the homeless mentally ill population living in the City of St. Louis. People who are homeless and mentally ill may use the Mentor Center as a daytime safe haven or a place to do their laundry or shower. It is our expectation that the Mentor Center will provide a site at which homeless mentally ill people can interact with a variety of helping prosumers and professionals using the model of integrated service delivery embodied in the federally funded ACCESS program operated out of St. Louis Mental Health Center. This program stresses the "no wrong door" philosophy that allows homeless mentally ill people to make the contacts that they need though a variety of participating agencies. Representatives from a variety of public and private agencies will be on-site at scheduled times to take applications for their programs and to provide information and education. The peer drop in center associated with the ACCESS project in Kansas City models this method of service delivery by having a representative from disability determinations take SSDI and SSI applications at the drop-in center. Other centers have on site DFS workers at regularly scheduled times. Vicki Fox Wieselthier, the President of the DMDA Board of Directors, serves on both the state and local coordinating councils for this grant and is the System's Integration Coordinator for St. Louis Mental Health Center and the ACCESS grant. Joe Yancey, the grant's project director, is excited about the possibilities for outreach and engagement that the establishment of the Mentor Center promises. We expect to reflect the "no wrong door" approach throughout our program and make its benefits available to everyone, not just the homeless population. Although people who attend the Mentor Center will be asked to supply demographic information for evaluation and utilization purposes, we will not require that they provide evidence that they are currently receiving mental health care. Drop-in centers provide a unique opportunity to outreach and engage people who have either fallen through the cracks or opted out of "the system". We believe it is part of our mission to serve these people. We hope that as their level of trust in us increases they will be open to receiving the services they need from mental health professionals. In some instances, people will not be comfortable with providing anything but the most basic information about themselves before this trust level is established. We will provide linkage to the professional community and collect additional information (emergency contact numbers and the like) when they are ready. Requiring that consumers already be engaged in treatment or provide extensive information prior to the development of a level of trust is one way to "skim" as it effectively drives the people most in need of assistance away. Please refer to the Marketing Plan section of the grant for an explanation of skimming. The Mentor Center will be staffed by consumer workers. Two full time "prosumer" employees, who have education and/or experience equivalent to a bachelors degree in addition to being a consumer of mental health services will provide day-to-day coverage and training for the entry level paraprofessional positions throughout the program. These entry level, paraprofessional workers will function as Program Assistants throughout all Mentor Program components. Much of the Executive Director's time will be spent in direct services, including Program Assistant training, at the Mentor Center. Please refer to the staffing section of the grant application for more information about educational requirements for employees in the Mentor Program and a discussion of consumer employment. The Mentor Center will serve as a training base for Program Assistants (paid part-time consumer workers) involved in the Mentor Friendship Line, Individual Peer Support, or as facilitators for community based and/or facility based self-help/mutual assistance groups. We expect a consumer run banking system similar to the Independence Center's Member Deposit Account system to be one of the first services the Mentor Center offers. A Grace Hill M.O.R.E. Computer will be on site so program participants can access entitlement information, the Grace Hill work exchange, and information about community resources and employment. We hope that the independent living programs available to Grace Hill participants will also be available to Mentor Center members by way of the ACCESS Grant's cooperative agreement with Grace Hill. The M.I.K.E. Computer, funded with MHB funds in December 1994, will be available to Mentor Center participants who will be able to prepare resumes, write letters, sharpen job skills, or cruise the Internet. Our evening hours will permit the Mentor Center to provide around-the-job assistance to working consumers including support groups, recreation, and the companionship of their peers. Twelve step groups will be welcome to use Mentor Center meeting rooms. The Mentor Friendship Line will operate from the drop-in center. There will be a wealth of opportunities for engagement and involvement in recreation, education, and participation in self-help/mutual assistance activities. Educational Opportunities Professional agencies can be expected to provide information and education to Mentor Program participants at regular intervals. Thus one will be able to learn more about social security disability eligibility, vocational rehabilitation services, and Veterans programs on site. Mentor Center staff training on community resources, crisis management, group process, cultural competence, quality improvement methods and other topics will be available to program participants. Much of the training in these areas will be provided by organizations that have promised their assistance to us in their letters of support. The Mentor Center Program will be greatly enhanced by the current educational activities of the Mental Health Association. Throughout the year the MHA offers training to the professional community which will be open to Mentor Program participants. Past training includes stress management, programs highlighting specific mental illnesses and disaster preparedness. The MHA Mental Health theater program, The MHA Mental Health Players Troup, will be open to Mentor Program participants. Facility Based Self-Help Groups We will invite all of the organizations listed in the mental health section of the MHA 1996 Self-Help Guide to use the meeting rooms in the Mentor Center. In addition, we will contact AA Central Service so that 12 step groups are aware that the Center has meeting space available. Program participants will be able to start their own groups. Our evening hours will offer opportunities for consumers who are working to attend groups. Information about the groups will be available to the community. Please see our Marketing Plan for more information about this. We expect that some of the groups will focus on mental illness/mental wellness and its treatment while others will organize themselves around specific interests and needs. Some groups may attract members who are interested in attending a group which meets every week and which they plan on using for an indefinite period of time. Other people may wish to attend a group that meets for a limited period of time and provides assistance in a specific area. For example, one can envision an on-going support group for people who are dealing with symptoms and challenges of mental illness while working and another group which would meet for a shorter period of time designed to assist people who are planning a job search, writing resumes, and learning about their legal rights as working people with disabilities. Advocacy Advocacy is a natural part of Self-Help/Mutual Assistance. The Visionquest Chapter of the Missouri Mental Health Consumer Network will operate out of the Mentor Center. Legislative and policy issues will no doubt be popular topics in the drop in center. The library contains reference materials that will assist consumers interested in their legal rights and responsibilities. The program will collect and provide information to other consumers, professionals, family members, and other interested parties in the community in the areas of benefit acquisition assistance, individual advocacy, systems advocacy, legislative advocacy and civil rights. Community education will also be provided. The members and staff will undoubtedly seek out and identify emerging issues that affect mental health consumers in the St. Louis area. The program will work with existing community organizations in its advocacy efforts. For example, ROWEL (Reform Organization for Welfare) has a wealth of resource materials about entitlement programs that we could use in our efforts. Adequate Housing for Missourians has special competency in the area of low income housing. We would be foolish to duplicate services. It is far more productive to work side by side with these effective existing organizations increasing their knowledge regarding mental health and the needs of mental health consumers while improving our own skills and knowledge base in the areas that they possess expertise. Benefit Acquisition Assistance Program staff together with program participants will provide assistance to persons with mental illness and family members who are attempting to receive social welfare benefits. These benefits will include, but not be limited to, Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), Food Stamps, General Relief, vocational rehabilitation services, inpatient or outpatient treatment at public health facilities (not limited to psychiatric services), services from traditional day treatment facilities and housing and habitation services. Frequently mental health consumers, because of illness, medications, their position in society or lack of self esteem, are not empowered enough to take a strong stand in providing for their own welfare. The consumers most in need of information and assistance are often the least able to negotiate a system that is complex, fragmented, and always changing. Prosumer staff will be available to intervene with agencies to insure receipt of services and may accompany consumers to service providers for interviews, appeals, etc. Over time, program participants who have themselves successfully negotiated the various entitlement systems will be able to act as mentors and assist their peers. To meet the requirements of this program the Mentor Program will: * Provide consumers with eligibility information on programs that might provide them benefits; * Educate consumers about application processes, administrative appeals processes, benefit waiting lists, etc.; * Accompany consumers in need to interviews, hearings, etc; * Develop resource materials regarding entitlement programs; * Interact appropriately and as needed in an ombudsman role with appropriate agencies. While the primary customers of benefit acquisition assistance will be consumers, family members and mental health professionals will have access to our written materials and staff time when feasible. Systems and Individual Advocacy People with mental illness often find they need legal assistance. Sometimes that assistance is needed because of things directly related to their mental health status and needs. At other times they need help with more-or-less routine matters that are unrelated to their consumer status. Attorneys from the St. Louis Metropolitan area will be contacted and asked to provide pro bono services to discuss legal action or issues with Mentor Program participants in need. Legal Services of Eastern Missouri, the Law Clinic at St. Louis University, and Protection and Advocacy Services, Inc. will be consulted when appropriate. Resource materials such as the Legal Services pamphlet on tenant responsibilities and rights will be available to program participants. Both DMDA and MHA feel that this is a positive action to ensure that: * Mental health consumers have a legal resource to whom they can submit presumed legal grievances or accomplish such things as preparations of wills and divorce proceedings; * Consumers who feel they have been wronged by the system, discriminated against, or inappropriately denied services will have an opportunity to learn what the law is and what their rights are. At times consumers will find that they have no legal standing in the issues that they present, but surety in that regard allows one to move on to other issues and concerns. Individual Advocacy The Mentor Program will maintain a library of information on eligibility, application and administrative and legal appeals processes in the areas of housing, social welfare programs, insurance, in-kind programs, vocational services, managed care and clinical treatment. A list of contact persons within applicable agencies will be maintained. Much of this information is already available in the DMDA and MHA libraries. The M.O.R.E. information computer will be especially helpful in this regard. Technical assistance will be provided to consumers, family members and other interested parties serving as ombudsman for people with mental illness. Systems Advocacy The Mentor Center will maintain records of consumer grievances and complaints. Records will be kept pertaining to actions within the community that are perceived as discriminatory. Problem areas will be identified so that program participants can take action to correct, improve, or impact deficiencies. Persistent or flagrant violations of civil rights and/or the existence of class discrimination will be referred to Missouri's designated "Protection and Advocacy" agency, Protection and Advocacy Services, Inc., in Jefferson City, Missouri. The Mentor Program will also promote primary consumer involvement in the mental health policy planning arena. Program participant involvement in standing regional advisory and state advisory councils, boards of directors of not-for-profit mental health agencies, and the Protection and Advocacy system will be encouraged and facilitated. Information will be shared with other local, state and national self-help/mutual assistance groups. Access to national advocacy information will be available through subscriptions to advocacy related journals and through the internet. Another area of system's advocacy involves legislation. Mental health policy and legislation are entwined in ways one does not find in other areas of health care. Changes in services and systems almost always require legislative action. In Missouri, the organized consumer movement has not been very strong despite the presence within the state of several very influential consumer leaders. The DMDA has long held that it would not devote its resources to legislative/political advocacy. While it has always distributed advocacy materials to its members, and maintains a library of current legislation, action alerts etc., the organization has felt that no person should feel unwelcome or threatened because they do not share the organization's political viewpoint. Much of the information on current legislation will come from the resources of the Mental Health Association of Greater St. Louis which currently maintains an active legislative component. It is likely that Mentor Program participants will be more political and less conservative than either MHA or DMDA. Civil Rights The Mentor Program staff and members will prepare, publish and disseminate information that pertains to the rights of people with mental illness in the St. Louis Metropolitan area. We will make available information prepared by other organizations as well. The information might include, for example, such issues as: * Commitment laws and legal rights while within the commitment process (right to an attorney, speedy hearing, right to be present at hearings, etc.); * Rights that inpatients have under the law in Missouri (right to: a telephone, privacy, safety, privileged communication, to have visitors, to be involved in treatment planning, to petition the court for release: to present administrative grievances, etc.); * Aspects of guardianship, outpatient civil commitment, conditional release. Information on civil rights and other advocacy issues will be available both on site and through the Mentor Friendship Line. Recreational Activities The daily activities within the Mentor Center will be varied, interesting and appealing to a diverse group of mental health consumers. Recreational activities and pursuits, and opportunities to socialize and form friendships will be primary. Every attempt will be made to make the Mentor Center a favorable alternative to isolation at home. A game area will feature ping pong or a pool table, card tables, games, a coffee pot, and snacks. There will be a reading room for individuals who need and appreciate quiet space. Books and magazines will be available. A large color television with a VCR will be on site. Outside recreational activities will include softball games during summer months, perhaps with other day psychiatric facilities in the Greater Metropolitan St. Louis Area. We expect that members and staff will work together to obtain free passes to Monday evening trips during the summer to the St. Louis Municipal Opera, trips to Cardinal baseball games, and other athletic events. Other recreational activities may include picnics, barbecues, swimming, basketball and volleyball at a neighborhood YMCA, camping trips or retreats, ice skating, and other activities. Members and staff will together make the financial decisions that determine which activities they choose and will have control of the food and recreation budget. Transportation to outside recreational events will generally be by public transportation although from time to time staff and members' private vehicles will be used. Carol T. Mowbray, an associate professor at Wayne State University, School of Social Work, has made an extensive study of consumer run drop-in centers. In the Community Mental Health Journal published in March 1992 she concludes: "In summary, the consumer-run drop-in center is an innovative model that deserves expansion and replication throughout mental health systems. However it is important to ensure that the model is truly consumer-run and that it has direction, technical assistance, and support from the consumer movement as well as collaboration from mental health professionals, including assurance of adequate funding levels." The Mentor Center will be a wonderful example of the kind of drop-in center that Mowbray so admires. Both the Mental Health Association and DMDA-St. Louis have the consumer and professional connections that she finds essential. The Mentor Center will also serve as a training site for mental health professionals. Dr. Maria Bartlett, Chair of the Health Concentration at SLU School of Social Service, and Dr. Cathryne Schmitz, Chair of the Community Concentration at SLU, have both indicated that they would like to be able to place master's students at the site for practica. Their letter of support can be found in the attachments on file with the Mental Health Board. Dr. Jean Campbell is actively looking for opportunities to use the Mentor Center to demonstrate consumer delivered services and has already written the Mentor Program into one grant application which has been funded. A fee will be available to the Mentor Center in 1997 for participation in this project. By providing training opportunities and participating in research projects the Mentor Center will have a dramatic impact on the way mental health services are delivered in the future. We look forward to developing the partnerships that will bring these plans to fruition. We are convinced that if consumers are offered access to self-help/mutual assistance in a pleasant, spacious setting they will do far more than drop-in. The facility we have planned in the MHA building will be large enough to support a variety of activities occurring simultaneously. The St. Louis Alliance for the Mentally Ill has already agreed to co-locate its minority outreach activities at the Mentor Center. We expect the Mentor Center to become a valued part of the St. Louis mental health community. MHB funding of the Mentor Center will: * Create a Peer Run Drop-In Center in the City of St. Louis; * Empower consumers to become independent and interdependent; * Complement existing community mental health resources by providing alternatives for consumers for whom existing programs are not a "good fit" or for whom no funding is available; * Expand access to recreational, social, educational, and self-help/mutual assistance activities; * Develop leadership, competency and expertise within the St. Louis consumer community; * Foster acceptance of professional mental health services without making acceptance of professional services a precondition for participation in activities or opportunities; * Enhance social and interpersonal skills by providing opportunities for consumers to use those skills; * Reduce social isolation; * Provide a location at which to develop "specialty" support groups. Groups will form in response to program participants' interests. Some groups will have a definite mental illness or MI/ADA focus while others are likely to reflect the leisure, recreational or more general interests of program participants; * Improve consumer access to the existing educational programs of the Mental Health Association and lead to development of richer and more varied training opportunities; * Provide around-the-job supports for working consumers; * Provide training and employment opportunities for people with serious and persistent mental illnesses; * Provide a city location at which various kinds of individual, systems, and political advocacy will flourish; * Strengthen our relationship with existing community providers of both mental health and non-mental health services. Community Based Self-Help Groups The DMDA has operated community based self-help groups in the St. Louis area for fifteen years. Consumer run, these groups assisted over 1000 people in 1995. Approximately two hundred of them were St. Louis City residents attending our Community Based Self-Help Groups in the City. An additional 100 City residents received assistance from DMDA-St. Louis by attending Community Based Self-Help groups in St. Louis County. While the mission of the DMDA has, nominally, been limited to providing self-help/mutual assistance to persons with affective disorders, in truth these groups have always been open to any mental health consumer able to participate in the group process. No one has ever been asked to leave a DMDA group because he or she did not meet diagnostic criteria. DMDA currently conducts twelve meetings a month in the City of St. Louis. The weekly meetings held at Jewish Hospital provide a self-help/mutual assistance experience for people who are dually diagnosed with mental illnesses and alcohol and/or substance abuse using a 12 step model of recovery. It is one of only a handful of dual diagnosis groups in the nation with an official AA connection and full AA recognition. Although the weekly meetings which take place at Lutheran Medical Center do not have this specific focus, it is estimated that 50% of those in attendance are dually diagnosed. The meetings support the recovery process. The four meetings a month held at St. Mary's Health Center in Richmond Heights attract a group which is largely composed of City residents. A new DMDA group serving the needs of Gay and Lesbian consumers began operations in the City of St. Louis in January, 1996. One of the group leaders for this new group is also an instructor at St. Louis University where she is responsible for teaching a course on HIV and AIDS to social work students. As some people develop mental illness secondary to HIV infection, her expertise will be especially helpful. This group leader is also a member of the DMDA Board of Directors, as is the consulting professional for this group. The Mentor Program will expand the availability of Community Based Self-Help Groups in the City. These groups will be open to any City resident with a mental illness. We plan to identify and train an additional four group leaders. Hopewell Center has promised to assist us in identifying African-American consumers who would like to fill this role. Once two of these group leaders are trained, we will begin a weekly meeting at a North St. Louis location. One of our senior group leaders will assist in the development of this group and will co-lead for approximately three months. Additional North St. Louis groups will be formed as demand for them dictates. Dr. Amanda Murphy has graciously offered Hopewell Center as a site for a support group. Approximately 25% of the Director's time will be devoted to outreach and engagement activities. This, in combination with assistance from the African-American Church's Task Team and Hopewell Center, will assure meaningful participation in all Mentor Program activities by the African-American community. Letters of support from both the Hopewell Center and the African-American Church's Task Team can be found in the attachments on file with the Mental Health Board. Ronald Miller of the St. Louis Board of Education management team has offered space in the Community Education Centers operated by the Board for Mentor Program support groups. These Centers are one of the most exciting innovations in St. Louis. They are open evenings and on the weekends to community organizations like ours. Events in these centers are well publicized and are gaining in acceptance by the local communities in which they operate. Ties with the Community Education Centers will greatly strengthen our marketing efforts. Some of the Community Education Centers are also Caring Community sites. The Caring Community concept has been expanded to 18 city locations this year. It offers an Afro-Centric, family centered approach to the prevention of common social and health related problems faced by families including mental illness. One of the Caring Community site coordinators sits on our Board of Directors and will assist us in establishing a relationship with this important community resource. It has been our experience that people who use self-help/mutual assistance groups are often in need of additional supports. The enhanced training we will provide to our group leaders should be most welcome. Of course, people who attend the Community Based Self-Help Groups may choose to use other elements of Mentor Program services. Because the Mentor Center will be open ten hours a day, including evening and weekend hours, group participants will be able to access self-help/mutual assistance far more easily should they need or want more support. As with our existing self-help groups, the new support groups will offer extensive contact with mental health professionals. Very often people who attend a Community Based Self-Help group tell us that they wish they had known about the existence of self-help groups earlier. They tell us that they have been receiving treatment for a mental illness for years, but have never been referred for self-help/mutual assistance. For this reason we will be actively outreaching the professional community. We will also be listing our groups in the calendar sections of the neighborhood newspapers regularly and taking out small display advertisements in the minority press to announce our new North St. Louis group. In the past DMDA-St. Louis has been hesitant to advertise our groups because we did not have the resources necessary for expansion or additional group leader training. No MHB funds will be used to subsidize groups taking place in St. Louis County. MHB funding for expansion of our Community Based Self-Help Groups will: * Provide effective outreach to the African-American Community; * Establish at least one weekly North St. Louis Community Based Self-Help Group; * Educate professional providers of mental health services including those employed at in-patient facilities, psychosocial rehabilitation centers, and community mental health centers operating within the City of St. Louis about the value of self-help/mutual assistance; * Recruit additional African-American group leaders; * Enhance group leader training by increasing knowledge regarding self-help/mutual assistance techniques, expanding expertise and technical knowledge regarding all of the serious mental illnesses and alcohol/substance abuse, and ensuring cultural competency; * Market our self-help/mutual assistance groups which meet in the City so that it is clearly understood that these groups are available and open to St. Louis City residents with any of the serious and persistent mental illnesses and to persons who are dually diagnosed (MI/ADA). Mentor Friendship Line (Peer Phone support) The Mentor Friendship Line ultimately will, when fully operational, operate from noon until 10 PM, seven days a week. It will be available both to City residents who have connections with professional mental health agencies and those who do not. We expect that, for some people, it may be their first contact with self-help/mutual assistance. It may also be the first step to wellness for people who need and will benefit from professional mental health services in the future. The Friendship Line will also serve as a marketing tool for the rest of the Mentor Program. Social isolation and feelings of loneliness are common denominators of the consumer experience. These are often most intense in the evening when access to drop-in centers, psychosocial programs and community activities is limited. Frequently consumers call Crisis Lines and facility-based emergency numbers in ways that these services see as inappropriate. An analysis of over 200 calls made in the evening to the on-call staff at St. Louis Mental Health Center revealed that less than 10% of the calls made over a six month period needed the immediate attention of a mental health professional. In St. Louis, consumers frequently call crisis lines when they need someone to talk to. The Life Crisis Line recently suffered funding cuts which have reduced their ability to respond to the huge number of callers using this service. It is not at all unusual for people in crisis to be put on hold until a trained crisis worker is available. A letter of support from Lee Judy, the Executive Director of Life Crisis Services, can be found in the attachments on file with the Mental Health Board. Throughout the country, friendship lines have been put in place to reduce consumers' social isolation and ease the burden on facility-based on-call staff and crisis workers. Central Kansas City Mental Health Services has successfully operated an evening friendship line for its clients, funded by their Mental Health Board. Their friendship line does not operate during daytime hours because all of the persons served by the line are also receiving services through the mental health center and receive daytime support from the agency. Over the last one year reporting period, consumer Friendship Line Workers provided friendship and support to almost 800 evening callers in Kansas City. Many of these calls undoubtedly would have been made to overtaxed crisis and on-call professionals had this service not been available. The advocacy assistance available on site at the Mentor Center will also be available through phone consultation to Friendship Line callers. A tracking system for calls will be developed so that we fully understand the concerns of our callers and respond appropriately. If, for example, we find that we receive frequent calls for information on a particular topic, we may decide to prepare a special brochure on that topic or plan an educational program that addresses that issue. In the future, this particular component could be funded by the Department of Mental Health as part of the continuum of care offered through the planned state wide crisis service. To further this goal, we will evaluate the Mentor Friendship Line both in terms of consumer satisfaction and as its impact on the utilization of crisis lines. Funding for the statewide crisis system has recently been achieved and will soon be implemented in the St. Louis area by Behavioral Health Response (BHR), a not-for-profit organization comprised of the five local administrative agents for the Department of Mental Health. BHR will assist in the development of the Friendship Line and will both step-down to us and accept step-ups from the Program Assistants staffing the Friendship Line. Additional training for Program Assistants will be provided by Life Crisis Center and Mentor Program staff. BHR board members have assured us that they will make every effort to fund a portion of the costs associated with the operation of this service. As the BHR service is not yet fully operational, no specific financial support can be obtained at this time. Mentor Program staff will meet regularly with Program Assistants to make sure that they are comfortable with their role and that they are not attempting to provide crisis services. Program Assistants will also receive on-the-job and around-the-job assistance and support. In particular we will attempt to establish linkage with vocational rehabilitation and educational opportunities so that Program Assistants can see their Mentor Program employment as the beginning of their working lives. Funding for one FTE of Friendship Line Program Assistant staffing will be obtained through other funding sources. MHB funding of the Mentor Friendship Line will: * Provide friendship, support and assistance over the phone to consumers who are not in crisis but who are experiencing distress due to social isolation, loneliness, or troublesome symptoms of their illness or who require advocacy assistance and referral; * Decrease the dependence of mental health consumers on professional staff to overcome feelings of loneliness and social isolation; * Reduce the utilization of Crisis Lines and facility-based on-call systems by consumers who do not need the immediate assistance of mental health professionals; * Create an interface with mental health professionals and trained crisis workers so that consumers who do indeed need more intensive services are able to access them; * Provide training and part-time employment to culturally competent, racially diverse mental health consumers who exhibit the ability to listen empathetically and understand fully the non-clinical, non-professional nature of their responsibilities; * Engage persons using the Mentor Friendship Line in other self-help/mutual assistance activities; * Market this service to St. Louis City residents with serious mental illnesses. Individual Peer Support Not everyone who would benefit from self-help/mutual assistance chooses to receive that assistance in group settings or at fixed sites in a mental health environment. The Individual Peer Support (IPS) component of the Mentor Program will provide opportunities for consumers to form relationships with other consumers who receive specialized, ongoing training so that they can ease the way into activities in integrated community settings. Central to the successful operation of this program component is the development of a respectful, comfortable working relationship with the community mental health centers located in the City. Individual Peer Support workers will be matched with consumers who would like a "buddy" willing to spend about four hours a week with them. Together the two of them will explore the city and participate in activities in the community. The Individual Peer Support worker will receive pre-service and ongoing in-service training. Mentor Program staff and mental health workers at referring agencies will work together to match clients with a Peer Support Worker. Both the IPS Coordinator and agency staff will assist the Buddy Pair as they establish and develop their relationship. Each Buddy Pair will receive $20/MO to spend while they are out in the community. Receipts will be required for reimbursement. Program Assistants will also be provided with Bi-State Bus Tickets rather than being reimbursed for mileage. Community support workers sometimes take their clients out in the community by picking them up in their cars and taking them someplace they could never go on their own. Individual Peer Support workers will be encouraged to help their buddies develop familiarity with public transportation so that a trip to the zoo does not seem like a scary or impossible undertaking. Training and supervision of Program Assistants working as Individual Peer Support workers will take place at The Mentor Center. There will also be group meetings for people working in this program. Social events for "Buddy Pairs" will take place both at the Mentor Center and in the community. We will evaluate and monitor this program carefully as it is our belief that this program component can achieve the kind of positive outcomes which will make it attractive to outside funders. Based on the Rhinelander Program, a time limited, federally funded demonstration project at St. Louis Mental Health Center, and St. Louis Effort for AIDS' Buddy Program, this program component is expected to reduce social isolation, increase participation in community activities and reduce the overall costs associated with treating persons with serious and persistent mental illnesses. It also creates employment and training opportunities for persons with mental illnesses who may wish to pursue additional education in the area of mental health. A three year demonstration funded by the National Institute of Mental Health and the Center for Mental Health Services concluded that "consumer-providers do in fact bring unique characteristics and contributions to the mental health workplace that are non-reproducible by non-consumer paraprofessional workers and that these unique factors are what makes the difference in clients' lives." Individual Peer Support workers will receive MHA Compeer training. This well tested and effective program is a natural fit with the Individual Peer Support component. Program participants will be able to access both the non-consumer Compeer program volunteers or Individual Peer Support workers. The Individual Peer support program is more intensive than Compeer and will be ideal for people with more intensive needs. People who would like to become part of a "Buddy Pair" could be receiving professional services from any, or none, of the City's professional programs. Individual Peer Support workers could be clients of any of the area programs as well. One of the more significant problems with this sort of program has arisen when clients of an agency become paraprofessional employees of that same agency. For example, at a recent conference an agency director for a program in Johnson County, Kansas reported that he recently laid off a worker because she had stopped taking her medicine. When asked if the worker had exhibited any symptoms or if her job performance had suffered, the agency director replied that she appeared to be fine, but it was felt that there should be some "natural consequence" for her non-compliance. Even though these situations are not an everyday occurrence, it is difficult at best for a person to both receive services from agency personnel and, at the same time, be viewed as a competent and full member of a treatment team. Mentor Center Individual Peer Support will, of course, supplement professional assistance. In some instances it may lead to initial linkage with community based professional services after an in-patient hospitalization. It could also play an important role in a consumer's transition to full integration in the community with reduced professional contact. We would hope that professional providers would contract for Individual Peer Support services through the Mentor Program in the future. We are also exploring the idea that family members might want to contract for Individual Peer Support services for their loved ones. Individual Peer Support workers could deliver respite care for families needing it. Respite Care funding was approved in the 1996 DMH budget and will soon be available. The Missouri Mental Health Consumer Network is very involved in designing the Respite Care program and is dedicated to insuring that the program is designed so that consumers can qualify as respite providers. The Department of Mental Health is providing over $20,000 targeted to Individual Peer Support. This has cut in half the amount of funding needed to implement this component at a level which will provide four hours a week of Individual Peer Support services to eighteen consumers. The Department of Mental Health funding is primarily for persons being released from Metropolitan Psychiatric Center (Malcolm Bliss Mental Health Center) or who have a history of homelessness. In our budget pages, we have broken out the costs associated with operating Individual Peer Support. We believe that it is very important that the Mental Health Board understand the full cost of implementing this program component. Below you will find a table with the cost annualized. Although we believe that growth in this service might very well be paid for by DMH, we cannot, of course, guarantee this. The Individual Peer Support Coordinator will be responsible for marketing this service to family members, community agencies, and other potential sources of referral and financial support. The coordinator will also be responsible for on-going training and supervision of the Peer Support program assistants. Programs similar to this one historically have used both volunteers and paid staff. During the course of the St. Louis Mental Health Center study, approximately 20% of those persons who were hired to provide peer support later provided the service as volunteers. Consumer workers also chose to spend many more hours than they actually were paid for with the people they were helping. The table below does not reflect these possible cost reducing factors. MHB funding of Individual Peer Support will: * Increase opportunities for people with serious mental illness to actively participate in community life; * Reduce reliance on mental health professionals to meet consumers' needs for recreation, social support and companionship; * Aid people as they attempt to transition from facility based mental health daytime activities to activities in integrated community settings; * Reduce the overall costs of treatment of persons with serious and persistent mental illness; * Meet the needs of consumers who do not choose to receive self-help/mutual assistance in group settings; * Promote effective partnerships between mental health professionals and the practitioners of self-help; * Provide respite and relief to families of persons with mental illness; * Engage, train, and support consumers who function as Individual Peer Support Workers. Quality Development and Program Evaluation TQM and the Mentor Center If we had a dollar for every continuous quality improvement team that has been set up in the past few years, DMDA and MHA would not have to turn to the Mental Health Board of Trustees for funding. That said, there is a natural affinity between consumer operated programs and TQM. Both stress the primacy of customer (or consumer) satisfaction and recognize staff as internal customers. Both believe that you do not have good product unless you also have good process. The Mentor Program will operate within a framework of continuous quality improvement. All paid employees will participate in the formal quality improvement process by being part of quality improvement teams with program participants. Missouri, like many other states, has a not-for-profit organization which provides training and guidance in the implementation of quality improvement activities within organizations. This organization sponsors the Missouri Quality Award (MQA) which is based on the Malcolm Baldridge Award standards. Gary Sluyter of MIMH is both a Baldridge examiner and a Missouri Quality Award trainer and examiner. Gary Sluyter is also nationally known for his work and research in the area of implementing TQM in mental health organizations. He has indicated that he would be interested in providing guidance to a consumer run program in this area. We hope to use him as a resource in establishing our TQM program. Vicki Fox Wieselthier, DMDA Board President, has received extensive TQM training both from Sluyter and as a participant in Missouri Quality Award activities. She was a presenter at the last Total Quality Management in Mental Health Care Conference and is a co-author of an article which was published in the JCAHCO journal in January, 1996. Wieselthier will provide Board leadership in implementation of the Mentor TQM Program. St. Louis Mental Health Center's quality facilitator, Chris Lhotek, will do some training in this area as well. The first step will be to establish a Mentor Program Quality Council to establish a training program in TQM for staff and program participants and to guide the continuous quality improvement process. The Executive Director of the Mentor Center will have special responsibilities in the implementation of the quality program. Experience in assuring quality will be one of the characteristics we will be looking for during the recruitment and hiring process. Program Evaluation Dr. Jean Campbell, MIMH faculty and DMDA Board Member, will be overseeing and developing our program evaluation processes and procedures. She has provided the following statement to us describing some of the essential components of the evaluation protocol the Mentor Program will be using. The last paragraph of the piece she provided explains the services she will be providing to us: "The evaluation protocol of Mentor Program will utilize current knowledge and evaluation methods developed by consumer evaluators to collect program data and service outcomes of community-based peer support programs. It has been found that the recognition of participant values in an evaluation system is the key that opens the door to useful information about what a program is doing and whether or not it is accomplishing its aims. Therefore, it is important that the evaluation protocol embody the values of the Mentor Program members by using measures derived from their experiences and points of view. Consistent with a peer support philosophy, the development of evaluation protocols that are administered by peer-support staff have established the ability of consumers to conduct data collection activities. Jean Campbell, Ph.D., research assistant professor at MIMH and a noted consumer researcher, will assist in the development of the evaluation protocol for the Mentor Program. It will include qualitative and quantitative methods for consumer input at all levels of system design and implementation and will have the following design elements: Core Data Set: A core data set consistent with current DMH practice to include demographic information and data on service utilization will be collected. Multiple Outcome Domains: The result of services or impact on members will be measured using a Likert scaled, self-report tool. Since change in one outcome domain (e.g., employment tenure) may or may not coincide with change in another (e.g., empowerment), each identified domain will be organized as a separate data collection module. Simplicity: The measures to be included will be accessible to and easily collected by the program. Most measures will be able to be converted into "headcounts" of program members' status on a particular outcome indicator. Further, the data collection tool will be short to economize on staff and respondent resources. Face Validity: The measures will operationalize changes that are relevant to the program, and which are readily understood by non-researchers. Continuous Quality Improvement: Both the program and the evaluation system will continue to evolve and change as it is utilized, and as feedback facilitates programmatic and quality improvement changes. Human Subjects Protections: The system will place the rights of those people from whom the data is collected above any need for information. Subject rights to be included in data collection include privacy, confidentiality, informed consent, and easy access to one's own data as well as all aggregate data reports. In collaboration with the Mentor Program staff and members, Dr. Campbell will produce a software data collection program and evaluation protocol to include definitions and instructions, data collection forms, and a member self-report program assessment tool. Dr. Campbell will also provide staff training sessions and ongoing technical assistance on data collection, management, and security. A manual will be developed with specific instructions for and examples of gathering domain-specific data on program members along with definitions of outcome indicators for each domain, a data collection form for demographic information and process outcomes, a member self-report survey for assessing outcome domains and program satisfaction, instructions on electronic and ledger data management techniques, security protocols and generation of unique identifiers, simple methods of data analysis and presentation, and standards for human subjects protections in data collection and management. A baseline and follow-up assessment on a subset of members will be conducted in order to field test the evaluation system. The field test will be reviewed to determine the cost, appropriateness, flexibility, satisfaction, and reporting burden of the system for users and members. Necessary revisions will be made and staff retraining conducted prior to program implementation. Ongoing technical assistance and periodic data integrity assessments will be conducted by MIMH to insure fidelity of the evaluation system." Highlights of the Mentor Program Evaluation Program * Program evaluation information will be collected and analyzed continuously so that program deficiencies are not allowed to compromise quality and effectiveness of the services we offer. We cannot wait for the results of an annual assessment if we hope to be responsive to the needs of the men and women who participate in the Mentor Program; * The information gathered by this continuous monitoring of the Mentor Program will be essential to the operation of our continuous quality improvement effort; * Program participants, program assistants and prosumer staff all have important roles to play in the development and implementation of the evaluation program including: meeting together regularly to discuss program evaluation information, conducting the focus groups and interviews designed to capture program evaluation information, planning the corrective action that the results of evaluation indicate, following through on the deployment of the corrective action; * There is within the grant adequate staffing levels to be able to devote the time we need to collecting, entering and analyzing the data; * Program evaluation and continuous quality improvement responsibilities will be identified and detailed in the job descriptions developed for Mentor Program prosumer staff and program assistants; * It is absolutely essential that we actively seek out people who are dissatisfied with the program (and who have shown that dissatisfaction by leaving it) so that we may include their responses in our program evaluation; * We will need to develop an evaluation instrument which captures the attitudes of key stakeholders other than program participants. We need to fully understand the attitude of the mental health community so that we can be sure that we are sensitive to their concerns regarding the Mentor Program; * Program evaluation is a never ending process. Mentor Program Marketing Plan Ultimately, the success of the Mentor Program will be dependent on its ability to satisfy the consumers of mental health services who participate in its activities and on the program's acceptance and support by both the general community and existing mental health providers. The marketing plan described in this section will be an essential part of our strategy for developing a self-help/mutual assistance program which will be able to make a substantial difference in the lives of mentally ill persons residing in the City of St. Louis. Our marketing efforts will be targeted to: * Potential participants in Mentor Program activities; * Existing mental health providers; * Possible funders; * The general St. Louis community. Potential Participants in Mentor Program Activities It is easy to fall into the trap of thinking of "the mentally ill" as a single group of people with identical service needs and preferences. This is simply not true. DMDA has extensive experience running groups that serve a diverse group of people. Some people have a long history of severe and persistent mental illness which has seriously compromised their ability to form relationships, work, and live independently. Other program participants are able to maintain competitive employment, succeed in building strong, lasting relationships, and generally participate fully in the "American Dream" despite their illnesses and need for support and education. People who are homeless and mentally ill and people who are dually diagnosed with substance abuse problems have very special needs and preferences as well. The various groups do not necessarily mix well. This has led to programs which aim all of their activities at a particular kind of mental health consumer. Within the consumer movement this is known as skimming and scraping. Programs which skim design their services to attract people whose mental illness is truly an invisible disability and whose lives are not seriously affected by their illness. These programs can report high levels of success at helping people regain employment, continue their education, and reenter the mainstream. They are not necessarily welcoming to people who have had their lives and dreams destroyed by years of struggling with a serious mental illness. This group of people often find themselves involved in programs that scrape. Programs like this have limited goals for program participants and program staff concentrate on providing recreation, safety, and lunch. We believe that no person should feel that he or she is too well or too sick to be a welcome member and active participant in the Mentor Program. We also believe that over the course of a lifetime, people's abilities, needs, dreams, and expectations change. The Mentor Program seeks to provide a range of program activities which will support any City resident with a mental illness who has a need for support and the companionship of peers. We will have in place a menu of activities and opportunities which will appeal to a variety of people. It is our plan to market the Mentor Program activities to potential program participants by concentrating on the specific services that people find attractive to them. We expect to: * Develop a series of brochures describing particular program activities. These will be available at hospitals, psychiatrists and therapists offices, residential care facilities, shelters, DMH funded programs, and clinics; * Conduct and advertise one time educational programs with natural tie-ins to on-going activities. An example of this would be an educational program called perhaps, "Going Back to Work After a Psychiatric Hospitalization" which would be of interest to the same people who would like to attend a regular group focusing on this issue; * Offer and publicize a monthly "open house" to acquaint consumers with Mentor Program activities; * Publish a monthly calendar and list activities in the calendar section of local print media; * Acquaint Friendship Line callers with program activities; * Invite consumers to special events such as an ongoing series of discussions focusing on accessing social security disability, vocational rehabilitation services and entitlements; * List our activities on the City of St. Louis World Wide Web site currently being developed and in the resource section of the M.O.R.E. computer network operated by Grace Hill Communities; * Succeed at providing activities and programs consumers really like and are willing to recommend to their friends. Existing Mental Health Providers The Mentor Program will not succeed unless it becomes an accepted and valued part of the mental health community. This program is in some ways different from consumer run programs established in other cities. Many consumer run programs are started by groups of people who feel that the existing mental health system is always ( or almost always ( abusive and coercive. These people have often had disastrous encounters with the existing mental health system and come to the consumer movement full of anger and loathing of traditional mental health providers. The programs they develop reflect their anger. By way of contrast, the Mentor Program begins with the basic premise that has been true for the Depressive Manic Depressive Association from its inception. We believe that people make their journey to wellness in the company of their peers, their families, and trained mental health professionals. The Mentor Program is being developed as a community resource not because existing programs do not work, but because they do not work for everyone and because there are serious gaps in the eligibility for the programs that do exist. We will be marketing to the professional community with several goals in mind. We want line staff and administrators to understand the program so that they can recommend it to people who feel the need for the services we offer. We understand that some mental health professionals do not appreciate the value of self-help/mutual assistance. Part of our marketing effort will focus on helping them to understand that the Mentor Program can be a useful adjunct to existing services expanding the range of opportunities available to people with mental illness. We will work together with them to improve the lives of the consumers that come through all of our doors. We expect to: * Provide in-service training at existing agencies and nurture relationships with staff at these agencies; * Keep professionals informed about Mentor Program activities through brochures, program updates, and dissemination of our calendar of events; * Engage in and develop joint training programs with existing agencies; * Be welcoming to mental health professionals visiting the Mentor Center. We will have periodic open houses and educational programs at the Mentor Center designed to get line staff familiar with the facility; * Participate in the public life of the mental health community through active membership in the Mental Illness Awareness Coalition and similar organizations; * Offer a support group for mental health professionals who themselves have a mental illness. A proposal for this group was made to the DMDA Board of Directors in November, 1995. The group began functioning in April, 1996. MHB funds will not be used to support this group which meets in St. Louis County; * Develop, with the Missouri Institute of Mental Health, a series of programs which inform professionals about various aspects of self-help, consumer issues in treatment, empowerment, client rights and expectations. We will apply for CEU credits for these programs; * Provide a valuable service to people with mental illness which aids in their achieving the treatment goals that the professional agencies have established for them. Proof that the Mentor Program offers services which are effective will be perhaps the best marketing device of all. Possible Funders Although the Mental Health Board is the major funder of the Mentor Program now, we plan to diversify our funding sources as soon as possible. We have identified various sources of future funding and realize that effective marketing to these important partners will be absolutely essential. We know that we increase our chances of attracting funding if our activities are familiar, successful, trusted and respected. We have identified a number of potential funders. They include the United Way, the St. Louis Community Foundation, the Combined Health Appeal, the Department of Mental Health, the Center for Mental Health Services, and families with loved ones affected by mental illness. We expect to: * Be good community citizens by participating in the fund raising activities and educational programs of organizations like the United Way; * Send promotional materials, brochures, program updates, and calendars to potential funders so that they are aware of our presence and our impact before we ask them for money; * Present informational and educational programs about the Mentor Program at board meetings and meetings which offer an opportunity for community comment and presentations; * Offer our services to people who turn to these organizations for referral and assistance and report back to these organizations with the results of their referrals; * Demonstrate that we perform a valuable service to the community which is worthy of financial support and publicize our success. This is especially important if we hope to increase the amount of funding we receive from DMH and to be seriously considered for funding by the Center for Mental Health Services. A brief proposal for funding from the St. Louis Community Foundation has been accepted for consideration as a full proposal in July. DMDA and MHA are also developing a Venture Grant proposal for submission to the United Way. The General St. Louis Community We are well aware that the Mental Health Board has a serious responsibility to the taxpayers whose money supports the programs the MHB funds. Agencies receiving MHB support must, in turn, be responsive to the community which has made the decision to invest in mental health. The goals of marketing to the general community will focus on erasing stigma associated with mental illness thus making it more likely that St. Louisans will seek early intervention when mental illness strikes. We know that one in four families are effected by mental illness but that less then one out of every four people who need mental health care receive it. We also seek to improve the chances for mental health consumers to fully participate in community life ( including expanding their opportunity to be gainfully employed ( through the elimination of stigma. We are fortunate that both DMDA and MHA enjoy considerable community favor. The access to the media that the Mental Health Association has should be extremely helpful. We want people whose lives are touched by mental illness to contact the Mentor Program when they need education about mental illness for themselves and for the people they care about. We want them to turn to us for support, referral to professionals, and understanding. We hope to be a valued source of mental health education for the general community. People will not use us as a resource if they are not aware of our presence and appreciative of our expertise. We expect to: * Partner with organizations and agencies which do not have a mental health identity but which are concerned with issues that effect the lives of people with mental illness. This includes organizations focusing on the needs of poor people and the general disability community. Accomplishments by these partners will benefit program participants and will enhance the image of the Mentor Program. Examples of these types of organizations would be Paraquad and Adequate Housing for Missourians; * Maintain a high and positive profile in the media. A recent appearance by the DMDA Board President on KMOV's "Sunday in St. Louis" generated 142 calls for information and assistance; * Advertise our programs and activities regularly in the calendar sections of local papers with a special concentration on the minority press; * Offer educational programs and information about mental illness to the general community; * Establish a speakers bureau to give presentations to service organizations such as the Lions Club, and the Optimists. These organizations frequently make a monetary donation to the speakers' sponsoring agency; * Publicize our accomplishments and activities through press announcements. Knowledge regarding our accomplishments will ultimately be our most effective marketing tool. Outcomes, Utilization and Staffing Outcomes specific to particular program components are listed within the program description. We also expect quality of life outcomes which are program-wide. The Missouri Institute of Mental Health has pledged $20,000 of in-kind support to help us design and analyze our outcome measurements. Quality of Life Outcomes * Positive outcomes are expected which may include reduced isolation, improved relationships with family and friends, an increased willingness to accept professional services, decreased reliance on professional assistance for social support, and increased participation in community life including education, recreation and employment. Program participants will develop the outcome measures to be analyzed using a participatory method of outcome measurement design. MIMH will guide this process. * Program participants will demonstrate a high level of satisfaction with the program components they use. The level of satisfaction will be documented through the use of focus groups and formal satisfaction surveys. Satisfaction measures will be developed with the assistance of MIMH using a participatory evaluation design. * We will demonstrate and document our ability to provide opportunities to participate in self-help/mutual assistance services that are culturally competent and welcome in the African-American community. We will do this by establishing effective partnerships with the professional providers of mental health services in this community and providing cultural competency training to all of our staff and volunteers. African-American consumers will fill key roles within the organization. We will effectively market our services to the African-American community. Utilization * We will make steady progress towards the goal of having an average daily attendance of 35 people a day at our drop-in center in the 24th month of funding. Twenty people/day are expected to attend six months after opening the Mentor Center. * The Mentor Center will offer five Facility Based Self-Help Groups a week during month six of its operation. * We will operate four Group meetings a month at a North St. Louis location. An average attendance of 12 persons takes approximately one year to achieve. A group with an average attendance of 12 will typically serve 40-50 individuals in a one year period. A group with an average attendance of 20 will typically serve 100 people in one year. Success in this area is definitely related to our developing a successful relationship with Hopewell Center. * We will provide six educational programs in the City of St. Louis during the first twelve months of funding. Half of those programs will take place in North St. Louis. One of the programs will be a half day program introducing self-help/mutual assistance to families, professionals and primary consumers. 125 people will participate in these educational programs. These numbers may always be relatively small because we will be making a number of these presentations at small, non-traditional sites within the community such as Public Housing Community Centers and neighborhood health centers. * We will average 175 calls per month to our Friendship Line within six months of fully implementing this component. * We will successfully link 100% of those requesting it to professional psychiatric services. * We will provide in-service training at both Community Mental Health Centers operating in the City of St. Louis. In-service presentations will be offered to all of the in-patient facilities and psychosocial rehabilitation programs operating in the City. We expect to offer 8 in-service training's during year one. We should be able to offer twice that number in year two. * Through the Individual Peer Support component eighteen consumers will each receive four hours per week of Individual Peer Support during the period of the first year in which that program is fully operational. Our expectation is that we will provide 1000 contact hours of Individual Peer Support during the first 12 months of funding. * We will provide 6 FTE of consumer employment to persons working as program assistants. Funding of the Individual Peer Support program could provide an additional 2 FTE of Program Assistant consumer employment by the 24th month of funding. Mentor Center NEW 10 hours a day, 7 days a week. * 20/day at six months * 35/day by month 18 * 6000 in year 1 * 18,000 in year 2 Friendship Line NEW 10 hours a day, 7 days a week * 175 calls per month, month six of operation * 350 calls per month, by month 18 Community Based Self-Help Groups EXPANSION 8 groups a month currently 12 groups a month by 24th month of funding * 40 persons per week currently * 60 persons per week by month 24 * 4160 hours in 1995 * 6250 annually by month 24 Facility Based Self-Help Groups NEW Seven days a week * 50 persons per week at end of month 12 * 100 persons per week by month 24 * 1300 annually by month 12 * 4000 annually by month 24 Consumer Employment NEW 6 FTE by month 24 * 3060 annual hours of consumer employment w/o IPS by month 12 * 7140 annual hours of consumer employment with IPS by month 24 Individual Peer Support NEW Seven days a week * 18 persons receiving four hrs. of IPS /week by end of month 12 * 36 persons receiving IPS by month 24 * 1000 hours of Individual Peer Support by month 12 * 6000 hours annually by month 24 Staffing and Consumer Employment Staffing represents the single largest expense of this, or any other program. During the first few months of the grant these costs will be minimal as we will be hiring an executive director, bringing additional staff on, training staff, rehabbing our program space and easing into service delivery slowly. We have chosen to present a "snapshot" of the expected staffing pattern 12 months after funding is received. It should be remembered that this program will operate 10 hours a day, seven day a week. Staffing levels need to be adequate to assure coverage during these extensive program hours. It should also be remembered that staffing costs are considerably more than the amount of salary. Additional expenses for FICA, Insurance, etc. add greatly to the cost of doing business. Please refer to the budget pages for a complete accounting of these expenses. Throughout the grant application you will find references to consumer employment. Some background information will probably be helpful. Paid staff will be consumers of mental health/dual diagnosis services who have, through formal education and experience, developed the skills and competencies necessary to function on the professional level that their positions require. These employees are referred to as "prosumers". This term is becoming increasingly accepted within the literature in referring to consumers who are working as mental health professionals. We will be conducting a national search for a prosumer to direct the Mentor Program. The Mentor Program will also employ consumer paraprofessionals as Program Assistants. Program Assistant positions are not meant to be full time or permanent part-time employment. All too often, consumer employment opportunities are really dead ends for the people who accept the positions. We will avoid this by offering all Program Assistants linkage to educational and vocational opportunities which will aid them as they make the transition from being unemployed to being employed in a non mental health setting. Program Assistants will receive on-the-job and around-the-job assistance which will prepare them for leaving their paid positions as Program Assistants and moving on with their lives in the community. Expected Staffing at Month 12 of Funding Administrative Overseer $60,000 annually 1 FTE .05 FTE sought ($1200) MSW * Oversight of financial records, audit, bookkeeping * Liaison to MHA Development Specialist $30,000 annually 1 FTE .1 FTE sought ($3000) Training, experience * Identification of funding opportunities * Public Relations Executive Director $35,000 1 FTE .9 FTE ($31,500) MSW or equivalent * Outreach * Development * Training/Supervision * Direct Services Secretarial/clerical Staff $18,000 1 Appropriate training and expertise * bookkeeping * misc. support functions Drop-In Staff $20,000 2 Bachelor's Level or equivilent * Direct services to program participants including Program Assistants Individual Peer Support Coordinator $24,000* .5 ($12,000) MSW or equivalent * Development of IPS program and guidelines * Direct Services to IPS Program Assistants and Nurturing of the "Buddy Pairs" Program Assistants Mentor Center $10,400 2. none, extensive pre-service and in-service training * Direct Services * 100% Program Assistants FRIENDSHIP LINE $10,400 2 none, extensive pre-service and in-service training * Direct Services * 100% Program Assistants INDIVIDUAL PEER SUPPORT $10,400 2. none, extensive pre-service and in-service training * Direct Services * 100% Notes on the Budget Introduction The most difficult part of preparing the Mentor Program budget was determining the extent of program development that it should reflect. In an earlier grant application we decided to guess at the implementation schedule and show 12 months of funding beginning with the awarding of the grant. We were somewhat uncomfortable with this for two reasons. We do not really know with any degree of certainty how long it will take to hire and train staff and bring all four program components into being. We also were concerned that the first 12 months after issuance of the grant would not accurately reflect the costs of operating the program once the development and phase in period was over. For this reason we have decided to submit budget pages which more accurately reflect the costs of operating the program at the level we anticipate it will achieve between month 12 and month 18 of funding. We would expect that we will attract additional (non-MHBT) funding to accommodate growth beyond the level of support we are currently requesting. We believe that the $40,000 DMH contribution to our fledgling program reflects these possibilities. Budget Highlights Financial effect of this grant on existing operations of DMDA and MHA * DMDA will be moving its base of operations off of the State Hospital campus if this grant is funded. For the first time in several years it will have to pay for phone service. W