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This new writings page is under construction.
For your convenience the old Village website page containing Mark's articles is still available here.
A note from Mark: Since most of my writings collect dust in my loyal coworkers’ desks or in long neglected computer files, I used to describe them as “audienceless”. But as the years have gone on some have managed to take on a life of their own, thanks to the internet or word of mouth, usually unbeknownst to me. This website is an effort to collect all of my major writings in one, reasonably organized place where hopefully you will find them and make good use of them. You may copy articles to share, but please give me credit for writing them and don’t charge for them.
I’ve tried to put them in an order that makes sense to me, but, frankly, if your style of exploration is to wander here and there following your own interests instead of following someone else’s lead, feel free. Each article has an introduction to put it in some context so you won’t get lost
We’ll try to keep adding more things as I write them. I always enjoy feedback from readers and fellow transformation workers. Here’s an overview to orient you before you move on (click on the section description to see the articles in that section, be sure to use the scroll bars in each section to see everything):
Partners in Medication Collaboration – 1993
An early article for the CAMI Journal about the shift from medication compliance to collaboration
Rehabilitative Psychiatry – 1996
Fitting in as a psychiatrist working in a psychosocial rehabilitation setting
Hope and Schizophrenia – 1992
Like everyone else my personal transformation began with hope
The Four Walls – 1998
A shorthand view of four walls to break down to recovery oriented, used for handouts
Recovery with Severe Mental Illness: Changing From a Medical Model to a Recovery Model – 1995
My first detailed exploration of the recovery model for mental health building on other models of recovery
Four Stages of Recovery --2002
Brief overview of my “Kubler-Ross” four stages of recovery, used for handouts
A Road to Recovery - 2002
My book about recovery with the four stages, lots of stories, and practice implications. Available as a bound copy for sale for $10 by contacting Kate MacKenney at kmackenney@mhala.org or (562)285-1330 x244
Person Centered vs. Illness Centered – 2006
The most transformative mind shift in the recovery model is from illness centered to person centered; both for values and practice
We Treat Chronic Illnesses, Don’t We? - 2006
An article introducing recovery to highly medical model staff, meeting them where they are at - treating illnesses as well as they can and proud of it
Service Delivery
Transforming Staff/Client Relationships – 1994
A set of definitions of the elements of Village based services, contrasting them with traditional services
Mark’s Goal Setting Ideas – 2000
Concrete guidelines for case managers helping people set goals and grow
Recovery Based Service Delivery – 2006
Implementing the Recovery Based System Planning Schema for individual staff. Also “value driven and consumer centered” as a guide to decision making.
Ask Your Doctor about Recovery – 2007
An advocacy guide and schema for more recovery based relationships with psychiatrists and other mental health professionals
This Facility is Psychosis Accessible – 2008
A list of practical ways to make the value of “psychosis accessibility” a reality
Substance Use
Working towards Services for all Substance Using People with Mental Illness– 1994
My version of the NIMH four stages- engagement, persuasion, active treatment, and relapse prevention as a practical guide to dual diagnosis services
Creating a Dual Diagnosis Treatment Culture – 2004
Dealing with the emotional issues underlying our difficulties working with substance abusing people
Integrating Mental Health and Substance Abuse Treatment within a Recovery Framework – 2006
A vision of the possibilities of the implications of a truly integrated approach to dual diagnosis
Families
Friends with Families - 1997
Some musings on the difficulties working with families and an approach based on being “replacement peers” instead of “replacement families”
Advice for Families – 2009
An e-mail from a friend asking for help for parents of someone recently diagnosed with paranoid schizophrenia led to this response
Suicide
Challenging the Suicide Status Quo – 1999
A bold rethinking of suicide prevention from a person centered, subjective point of view worth considering given the Village’s remarkably low suicide rate.
Homelessness
Forming Treatment Relationships – Reach Out and Touch Someone - 2001
A set of six practical techniques for engaging people
American Refugees: The Village as Ellis Island - 2002
Reconceptualizing homeless people as “refugees in their own country” and our services as refugee services including practical implications
Who are the Mentally Ill Homeless? - 2003
My reflections on the “actual” diagnoses of mentally ill homeless people and the serious limitations of DSM for this group of people
Dr. Mark’s Ten Myths of Homeless Mental Illness – 2004
A very controversial article challenging the prevailing view that homeless mental illness is the result of deinstitutionalization when so many people were so impaired early in childhood
Give Me a Home – 2004
An overview of recovery based housing from vision to principles to practices
Psychiatrists
Let’s Include Psychiatrists – 1993
A brief list of six ways to include psychiatrists
Training Psychosocial Rehabilitation Psychiatrists – 1997
A discussion of psychosocial rehabilitation, not as an adjunct to medical treatment, but as an entire reframing of medical treatment including the nature of the therapeutic relationship, techniques, and desired outcomes
Medication Collaboration Strategies – 1998
A short list of my twelve instructions for psychiatrists
Psychiatrists’ Recovery Curriculum – 2003
Suggestions for key competencies for recovery based psychiatrists including engagement, assessment, treatment, and outcomes
Transforming Psychiatric Residencies – 2005
Recommendations for a model psychiatric residency training program to promote community based recovery psychiatry
Dr. Mark’s Guidelines for Psychiatrist Teamwork – 2009
A practical description of the psychiatrists’ job at the Village to guide case managers’ collaboration
Transitional Age Youth (18 – 25 year olds)
Diagnosis and Transitional Aged Youth – 2007
A discussion of the common diagnostic clusters that are messily combined in our TAY program
First Year Lessons from our Transitional Age Youth Academy – 2007
A frank discussion of the difficulties in working with TAY, and the hope
Rolling into TAY - 2007
Practical details of engaging TAY
Medications
Thoughtful Psychopharmacology – 2005
A set of considerations about medications that are crucial for prescribing effectively over the long term
Should the CATIE Study be a Wake-Up Call? - 2005 and Still Not Happy with CATIE - 2006
A full version of a letter published in the Psychiatric Services about the high profile CATIE study of antipsychotic medications wondering what went wrong and a follow-up letter
Can I Recover and Stop My Medications? – 2009
A lengthy response to a psychiatrist who wants to stop exposing her patients to recovery and the idea they can get off their medications
International Mental Health
A Personal Worldwide Perspective of Psychiatric Rehabilitation – 2000
Observations from a trip visiting psychiatric programs in twelve countries around the world
An Overview of the Village – updated 2008
A lengthy overview of the history, structure, design, values, and funding of the Village
20 Lessons of the Village - 1991
A short, still fresh list of pragmatic lessons learned in our first year
Wellness Center Ideas - 2004
An early description of some of the basic principles underlying our Wellness Center a rapidly growing and evolving level of service for self responsible people
Transforming MH Clinical Practices to Implement Recovery – Video Interview Lessons - 2004
Dan Fisher spent a day at the Village talking to our members on tape and these personal themes emerged.
Creating a Welcoming Center (with Shannon Legere) – 2005
A lengthy “nuts and bolts” description of how our Homeless Assistance Program functioned as a welcoming entry to the Village
An MHA-LA Exemplary Practice – Integrated Services (with Paul Barry) – 2009
A practical discussion of how and why to create integrated services instead of doing a few things well and the challenges involved
Up Close and Personal: A Plea for Emotional Closeness with Patients - 2004
A raw and confrontative discussion about why we stay emotionally distant from the people we’re trying to help
12 Aspects of Staff Transformation - 2004
A step by step review of the changes our staff went through to transform into recovery workers, useful as a short handout
A Guide to Mental Health Transformation on a Personal Level – 2005
A short book describing the personal changes we’ll all have to make including consumers and their families, staff, programs and their leaders, systems their administrators and auditors, and the community
Facilitating Transformation
What’s Really Different About Recovery? A Personal Commentary about the Transformation Process – 2005
A dramatization of what it’s like to walk into a skeptical room trying to push recovery
A Recovery Based Program Inventory – 2004
A set of questions useful for an internal self evaluation and discussion of how to become more recovery based
A Guide for Recovery-Oriented Leaders– 2005
A brief overview of the four values – hope, authority, healing, and community integration – we use in our recovery oriented leadership workshops
Facilitating Recovery Based Transformation: Where Are You? – 2006
A discussion guide following five stages of transformation to help plan transformation steps
Creating a Recovery Based Transformation Plan – 2005
A tool for creating teams of line staff and consumers to empower them to take actions they choose to promote recovery
Implementation Action Checklist -2007
A lengthy checklist created for clinic directors in LA county
Speaking Out in Public – 2006
A copy of a speech outlining the goals of the recovery movement for changing our community and the way people with mental illnesses are viewed
Keeping Perspective and Staying Sane -2006
Some tips for transformation leaders to keep us going
Defining the Goals
Spreading the Village – 1999
A list of a dozen “putting beliefs into practice” items that programs seeking to “replicate the Village” should look at
Wish List of Broken Rules -2004
A list of changes in administrative “rules” that would remove barriers and promote becoming a recovery based system
Recovery Based System Transformation Strategies: What Should We Do? - 2004
A brief set of goals for achieving system transformation that I described when California’s Proposition 63, the Mental Health Services Act, passed
Socially Responsible Mental Health Services – 2004
A discussion of public mental health services being not just medically responsible, but also socially responsible
Principles of a Recovery-Based Service System – 2005
A brief list of service principles based on recovery characteristics
Defining a Recovery Culture – 2005
A brief early effort to define elements of a recovery culture including different points of view
Recovery Based System Planning
Recovery Based System Planning (Part 1 and 2) – 2005
A comprehensive tool for system and program planning based on three stages of recovery – unengaged, engaged but poorly self coordinating, and self responsible
The Power of Flow – 2006
A detailed discussion of the issues around promoting growth and flow in our programs and systems to reduce stagnation, rising caseloads, and increasing front end rationing of services
Building New Recovery Based Programs
Designing Transformed Clinics – 2006
A practical guide to transform the structure of traditional clinics into a recovery based, growth oriented structure
Staffing Full Service Partnership Teams – 2006
Nuts and bolts discussion of staffing issues for recovery based ACT teams (In California they’re called Full Service Partnerships.)
Building Infrastructure and Administrative Tools
New Rules for Staff to Work By (with Rod Shaner) – 2006
A comprehensive set of recovery promoting parameters for service relationships developed and adopted by LA County DMH (that doesn’t prohibit hugs) for people who say “that’s against the rules”
Mark Ragins’ MediCal / Medicaid Thoughts -2006
A brief list of recommended changes in MediCal / Medicaid’s overarching design that would promote recovery
A Guide to the Milestones of Recovery Scale (with David Pilon) – 2006
A scale that replaces the GAS score that tracks people’s progress in recover and can help guide administrative and service decisions. The MORS has been highly developed by us including testing, training, and tracking.
A Recovery Based Progress Report Card – 2009
An auditing tool that tracks progression in seven key areas of recovery based culture to see if programs are “really doing it” and to get ideas for further improvements
Training and Workforce Development
Curriculum Outline Proposal – Helping Relationship Skills – 2005
Recommendations for a curriculum for training people, professional or not, to have relationship skills to help people recover
Hiring and Supporting Consumer Staff – 2006
A discussion of the importance of hiring consumer staff, the roles they serve, and the support and supervision needed to succeed