After the Vietnam War changed the course of his education, Michael Boyle found himself working in the psychology field. Employed with Fayette Companies since 1974 and now the company’s president and chief executive officer, Boyle says he couldn’t have found a more personally rewarding career.
Fayette Companies is a behavioral health management firm which provides comprehensive mental health and substance abuse services. Boyle also serves as project director of the behavioral health recovery management project and has more than 25 years of experience in the behavioral health field as both a clinician and administrator. His current interests focus on the integration of mental health, substance abuse and primary care services in addition to the application of a disease management model for behavioral health. Boyle and his wife of 33 years, Laura Simpson-Boyle, have one son, Sean, and live in the Peoria area.
Tell us about your background, schools attended and your family.
I graduated from Bradley with a degree in political science and with the intent of attending law school. This was in the midst of the Vietnam War; thus, further education was eliminated as an option. At the time, I was very opposed to the war and was your stereotype “hippie,” long hair, beard and all. I was offered a job teaching at a private church-operated school that provided a deferment from the draft. Some of the church members were involved in starting a youth outreach program and asked me to volunteer. I did and eventually left teaching to work full time with this program. A psychology professor from Bradley who conducted an evaluation of the outreach services, took me aside and basically said “Look, you have no training to be doing this, come to my office and I will enroll you in our program and we will teach you.” I realized he was right and proceeded to get a Master’s degree in psychology from Bradley. I had always enjoyed my undergraduate psychology courses and chance led me into a field that became extremely rewarding to me personally. I grew up with Fayette Companies, having been employed there or with one of the predecessor organizations since 1974.
My wife, Laura Simpson-Boyle and I have been married for 33 years and we have one son, Sean, who is currently working on his Master’s degree in bio-informatics at Indiana University.
Explain Fayette Companies and its related corporations.
Fayette Companies is a not-for-profit behavioral health management organization. We have several subsidiaries operating under different names that provide services to individuals and businesses. These include Human Service Center, White Oaks and Behavioral Health Advantages.
We were pleased to celebrate the 30th anniversary of the Human Service Center in 2006. We were originally formed through the consolidation of four separate agencies. The last 30 years have seen many changes:
• A budget growth from $500,000 in 1976 to $19 million today
• An increase in employees from less than 50 to 358 in 2006
• Growth from four facilities to 18 service locations
• Mental health services has grown from serving 80 to 1500 clients with serious mental illness annually
A major focus of the Human Service Center is comprehensive treatment services for adults with serious mental illnesses such as schizophrenia, bi-polar disorder or major depression. These services range from 24-hour mobile crisis response through our Emergency Response Service (ERS) to community-based case management. Three full-time psychiatrists and an advanced nurse psychiatric practitioner provide psychiatric evaluation and psychotropic medication prescribing and monitoring. Methadone treatment for heroin addiction and a long-term women’s residential treatment program for addiction and addiction services to the state’s work release program are also offered by Human Service Center.
White Oaks also provides treatment for alcoholism and drug addiction. We have a comprehensive system of services including medically-supervised detoxification, residential treatment settings, day and intensive outpatient programs followed by continuing care and specialized services such as in-home counseling for the elderly. Most of the services are gender-specific and are provided through separate residential and day programs for women and men.
We learned long ago that the needs of these populations are very different and require specialized treatment adaptations. An addition to the women’s continuum is the provision of ongoing recovery coaching. This service continues to provide support and case management to women in the community following completion of intensive treatment. Women are assisted in developing their own personal recovery plan that identifies their needs for recovery support rather than the traditional treatment plan developed by the professional staff. The recovery coaches then assist the women in implementing their plan. For example, while addiction treatment has traditionally “prescribed” participation in a 12-step program, a woman may find that participation in her church may be the best recovery support for her. Our goal is to empower and support her decisions.
White Oaks also provides both substance abuse and mental health services to youths and their families and several drug abuse prevention programs to schools and the community.
A third operating entity is Behavioral Health Advantages (BHA), a for-profit corporation. BHA contracts with employers to provide employee assistance programs and consultation. Another component of BHA provides counseling services for individuals, couples and families.
The Fayette family of corporations also includes the Human Service Center Foundation, Perry and Monroe Investment Company, a property-holding corporation, and Advantage Behavioral Health, LLC.
We are very fortunate to have a staff that is extremely dedicated to assisting those we serve and fulfilling the mission of the organizations. The work is very challenging and they are committed to doing whatever it takes, often in very creative ways.
How has the mission of Fayette Companies changed through the years?
At Fayette Companies, our mission statement is, “Engaging people in a life of recovery and assisting them to live their lives well.” While our mission of empowering and serving our clients has remained the same, the way in which we approach treatment continues to change, often dramatically.
Our mission statement offers several key factors to the organization. First, in addressing alcoholism and drug addiction, we need to focus on more than addiction recovery. Stopping drug use does not solve the myriad of life problems those we serve often face. We need to address employment, housing, supportive relationships and many other arenas to help people maintain their recovery and live their lives well.
Conversely, the mental health field has only recently begun to embrace the concept of recovery from serious mental illness. Across the nation, we have given the message that a diagnosis of schizophrenia results in little or no hope for one’s achievements in life, such as obtaining employment or advancing one’s education. How wrong we were and what great harm we imparted! We taught learned hopelessness. We now know that recovery is possible and in fact probable for the majority of persons with a serious mental illness. Our job is to assist them to gain hope, establish their goals and provide them with the knowledge and skills to support their recovery.
In addition to changing our beliefs, we are changing our treatment practices to those that have the highest scientific evidence of effectiveness. For the last several years, we have been training staff in the use of these evidence-based practices. We have brought some of the best clinicians and researchers in both mental health and addiction treatment to Peoria to provide training and consultation.
Many of these techniques are not really new. Some of the clinical trials demonstrating the effectiveness date back many years. In fact, studies have shown there is usually a 15 to 20 year gap between an approach in behavioral health having shown effectiveness and the adoption of the procedure in practice. The field has been inexcusably slow in giving up outdated beliefs and adopting techniques that will benefit a greater percentage of those receiving treatment.
Fayette Companies was recently selected to participate in a United Nations project. Could you tell us about this project and your role in it?
We are extremely honored to be selected as a member of the newly formed International Network of Drug Treatment and Rehabilitation Resource Centres. Please note the spelling of centres is correct in English and one challenge of working with this project has been to learn to write in English rather than American English. This project of the United Nations Office of Drugs and Crime, headquartered in Vienna, Austria, seeks to improve the access to and provision of effective drug treatment worldwide. Participants had to be nominated for consideration, and Fayette was nominated by the Robert Wood Johnson Foundation. One hundred nominees were selected to complete the application process and 20 were selected as participants. These 20 organizations are geographically located in all sections of the globe including Asia, Europe, Africa, South America, Australia and North America.
The purpose is to use these organizations as the “seeds” in each region to promote the most effective drug treatments. Unfortunately, most of the drug treatments currently used around the world were exported from North America and were flawed models based on belief systems and folklore rather than science. That is not to say these systems are bad, they just are significantly less effective than other models. Thus, the goal is to introduce the best treatments based on current research. A training center, housed at UCLA, will coordinate teaching these best practices from international experts to the participating organizations. In turn, the participants will first train others within their organizations to implement the techniques and subsequently serve as trainers to other providers in their regions of the globe.
Training manuals will be developed in the four areas of:
• Assessment and treatment planning
• Psychosocial treatments
• Use of medications
• Program management
The 20 participating organizations have also been assigned to four workgroups to develop best practice manuals in the following areas:
• Community Drug Treatment
• Drug Treatment in Prisons
• Role of Drug Treatment in HIV/Aids Prevention and Treatment
• Sustainable Livelihoods for Rehabilitation and Reintegration
Fayette also serves on the Sustainable Livelihoods workgroup with organizations from India, Colombia, Nigeria and Germany. The orientation of the work group is the identification of practices to support recovery following with active treatment and the return of the individual to their communities. This work will build on the principles of Behavioral Health Recovery Management, an initiative of Fayette Companies, to develop a disease management approach to address addictions and serious mental illness. A second focus is the development of recovery capital, which are the personal assets that can support ongoing addiction recovery such as family, social support and employment. My impression from my work with the United Nations is that many other countries are far ahead of the United States in incorporating employment as a major focus of treatment.
You mentioned that Fayette was nominated by the Robert Wood Johnson Foundation to participate in the United Nations project. How did the Foundation know about the work of Fayette?
Fayette has been working with the Robert Wood Johnson Foundation for the last three years on an initiative titled the Network for the Improvement in Addiction Treatment. We were originally selected as one of 16 organizations to participate in this project from over 450 applicants. Through a second round of applications and collaboration with the Federal Center for Substance Abuse Treatment, the Network now has 50 members in five states.
The original goal was to increase access and retention in drug abuse treatment through learning process improvement techniques. We have achieved remarkable results by learning how to assess our processes and undertake rapid change cycles. For example, in one of our residential addiction treatment facilities for women, 30 percent left against medical advice at some point during their treatment. This was reduced to 11 percent and the earnings increased by $166,000 compared to the same six-month period in the baseline year.
Our work with the Foundation has morphed into other initiatives. One of these is Innovations for Recovery which seeks to use advanced technologies for both treatment and ongoing recovery support. Fayette has been actively involved in the design and development of these new approaches and will be a beta site for their testing. Some of the technologies we may be using in the next few years are absolutely mind-blowing. For example, real-time 24/7 counseling and support will be available through a PDA type device. This could be triggered by remote monitoring of changes in an individual’s stress level.
We are also working with Illinois Central College on a proposal to the Robert Wood Johnson Foundation in response to their new initiative Jobs to Careers. The proposal will combine both on-thejob and web-based learning opportunities that will assist employed persons in addiction treatment to acquire knowledge and skills that will prepare them for promotions. We previously collaborated with ICC in developing a certification program in psychiatric rehabilitation that has allowed people to learn skills for jobs and advancement at the Human Service Center. Of particular interest is that some of the participants in the courses offered at ICC North had previously been hospitalized at the facility when it was Zeller. Now they go to that location for education. That’s what recovery is all about!
Have the numbers of individuals you serve for substance abuse in central Illinois increased in the past decade?
The numbers have increased but this is more of a result of our ability to create new services than a change in demand. Demand has always exceeded the resources available both locally and nationally. National statistics show only 10 percent of those in need receive annual treatment. This statistic must be tempered by the obvious fact that not all in need want treatment. That said, if only 20 percent of those in need desire treatment, less than half will receive it in any given year.
Has the age of the clients you serve increased or decreased? Why do you think that is?
We have experienced changes in both directions. We serve far greater numbers of older persons than we did a decade ago due to a single factor: we developed a service to meet their wants and needs. A few years ago, the former Director of the Illinois Division of Alcoholism and Substance Abuse asked us to develop a service for elderly persons. She had reviewed their data for the previous year and found that out of over 97,000 persons served with Medicaid or state funding, only 300 were over age 60. While that statistic was initially shocking, upon further consideration it made sense. Older persons with late onset alcohol problems often combined with or compounded by prescription drugs are not going to relate to an addiction treatment group composed of younger “street drug” users.
Thus, in cooperation with the Central Illinois Agency on Aging, we developed an in-home service called Day Break. Often our referrals come from the adult children of persons experiencing problems. The first task of the two counselors providing this service is to gain the trust of the older person. Thus, they may initially help them meet other needs they identify rather than starting with “I’m here to address your problem drinking.” Then, using motivational enhancement techniques, the counselors assist individuals to identify the problems drinking or the use of pain medications may be causing in their lives. The goal is to have the person develop a desire to eliminate or change use patterns to resolve these problems.
Another important element is beginning with a harm-reduction approach, if that is the person’s initial goal. This could mean reducing use or changing the type of alcohol consumed. For example, the person who for years consumed two scotches before dinner may now find that they can no longer effectively metabolize this amount of alcohol. Again, this may be compounded by interactions with the many prescriptions medications taken by elderly persons. If they decide to switch to a single glass of wine with dinner, we will support and assist them to monitor whether this eliminates previous problems caused by the hard liquor. Often people first reduce use or make a change and subsequently decide to eliminate all alcohol use. Taking an abstinence-only approach from the initial meeting would only result in a closed door to our counselors from many people who have eventually benefited from the services.
Regarding the younger population, we have witnessed a surge in people aged 18-25 with heroin addiction which is taxing our system. These are frequently coming from more rural towns and cities like Pekin, LaSalle and areas around Ottawa, in addition to Peoria. A supply of lower-cost and more powerful heroin has increased in availability. Worldwide production of heroin has increased significantly particularly due to the U.S. overthrow of the Taliban in Afghanistan. The Taliban had prohibited growing poppies that are used to produce heroin. Poppy growing now accounts for about 50 percent of the economy in Afghanistan.
We have been providing detoxification using buprenorphine, a medication recently approved by the FDA, and have been attempting to link people to an ongoing treatment program. For the younger population not in a long-term methadone treatment program, research is showing that buprenorphine is the more effective approach. We are now designing a specialized heroin treatment program for this younger population.
Is there usually a relationship between substance abuse and a diagnosis of mental illness in individuals?
Yes, there is a very strong relationship with problems in both areas being the expectation rather than the exception. I must caution that this does not imply a causal effect but rather is a correlation. A common myth is that persons with mental health problems “selfmedicate” with alcohol or drugs, implying that addressing the mental health issue will resolve the substance abuse. This is not true. Each disorder primary has its own etiology. The lifestyles experienced by those people with either disorder, often contributes to the creation of the other problems. For example, a very high percentage of women with addictive disorders have been physically and/or sexually abused. This may result in anxiety disorders like post-traumatic stress disorder that may interfere with continuation in treatment and recovery.
It is vital that persons with either disorder be assessed for the other condition and treated in an integrated manner for both. Far too often, people with co-occuring addiction and mental health problems become “ping pong balls” for professionals who claim they can only treat their specialty after the other problem has been resolved. In fact, dual disorders are so common that in 2002 Congress ordered the Substance Abuse and Mental Health Services Administration to provide them with a report on the organization and delivery of services for those with co-occuring disorders. I am proud that Fayette Companies was featured as a case study in the report regarding the process we have undertaken to integrate the treatments. I also serve on the National Task Force on Co-Occuring Disorders that is primarily composed of state directors of mental health and substance abuse services. This gives Fayette the opportunity to influence policy on a national level.
It is also important that behavioral health finds ways to integrate their services with primary health care. A significant number of persons we treat also have co-occuring health problems such as diabetes and hypertension. For example, the attending physician for our women’s residential addiction treatment programs, Dr. Sue Cole, tested the population for Hepatitis C. An astonishing 25 percent tested positive and 60 percent of those testing positive were unaware they had this chronic disorder.
Fayette has enjoyed a strong partnership with Heartland Community Health Clinic. Heartland operates a primary care clinic at the main Human Service Center outpatient mental health facility. The primary care physician, psychiatrists and nurses work as a team with a single medical record. Thus, each provider knows what treatment the others are providing and what medications have been prescribed. This greatly reduces the probability of negative medication interactions. When a person’s psychiatric symptoms are stabilized, the primary care physician can monitor their psychiatric medication which reduces medical visits and costs.
Conversely, HSC provides psychiatric time at the Heartland primary care clinic through a contractual arrangement. This expands psychiatric evaluations and prescribing for persons who do not have a serious mental illness that would require treatment by HSC. Heartland has also been a valued partner in accepting referrals from our addiction treatment programs of women and their children who do not have an ongoing primary care relationship.
Do individuals with one form of substance abuse usually move on to other forms?
Use of multiple drugs combined with alcohol abuse or dependence is the norm today. When I entered the field 30 years ago, there were clear distinctions. In fact, the person with an alcohol problem viewed drug abusers with distain and the opposite was also true. Prejudice was prevalent, based on the substance of choice. Today, while an individual usually has a primary dependency on a specific drug, whatever is available is often used.
What are the misperceptions people may have regarding substance abuse treatment in general?
Probably the biggest misconception has been perpetrated by federal agencies through their adoption of the slogan “Treatment Works.” For families and the general public, this slogan suggests that persons who enter treatment will maintain abstinence from alcohol and drug use. After all, that is the goal of treatment.
Let’s take in a dose of reality. Research from the National Institutes of Health demonstrates that treatment does “work.” The common measurements in these studies are a reduction in days and amount of use, not long-term continued abstinence. In fact, abstinence studies conducted over the last 30 years show only about 25 percent used no alcohol or drugs in the 6-12 months following treatment.
Yet family members and employers have been conditioned to expect absolute abstinence. If a person returns to use, usually the addicted person is blamed, of course, since “treatment works.” Would we expect a person with diabetes or depression to fully recover with no further symptoms after an initial treatment? How many families have been broken and how many jobs lost because a course of treatment did not “work?”
In fact, multiple attempts may be needed to achieve full recovery, as is common with smoking cessation, and each successive attempt should be celebrated. That said, it does not mean the person should go through the same treatment multiple times. It means picking up where one left off. The addiction treatment field must develop a better capacity to provide this individualized response.
What is the current school of thought among mental health professionals in regards to the causes of mental illnesses? Environment, heredity and social economic factors?
With regards to serious mental illness, current research points to what is called the stress/vulnerability theory. Simply put, there is a generic factor that puts some people at higher risk of developing brain diseases such as schizophrenia. This alone may be responsible for the onset of symptoms, usually in young adulthood. When extreme stress is added to the formula, more persons may develop the disease.
Research is pretty clear that a genetic factor is also present in development of addictions centering in the brain’s processing of the neurotransmitter dopamine. That does not mean that all persons with a genetic tendency develop addictions or that those without the genetic risk factor are safe. In fact, drug use appears to create the same brain-processing activity that is present in those at risk. Drugs or alcohol are needed for the person to feel “normal.” Thus, we truly have the chicken and the egg.
Environmental and social factors are extremely important in the initiation of drug and alcohol use. Also, studies have clearly identified that the earlier the age of first use, the greater the likelihood of the development of dependence later in life.
How does a mental health disorder or substance abuse addiction by one family member affect the others?
Often this creates great frustration and stress within the family. They want their loved one to get help but do not know what they can do. If they push their loved one or try to control them, the result is usually the creation of resistance and conflict. It is very, very hard for families to see their children experiencing psychosis and yet refusing to receive treatment or take medications. But, if a person is not a current threat to self or others, our free society allows them to make choices.
For family members wanting to help a loved with an addiction problem, I would highly recommend a new book, How to Get Your Loved One Sober, by Dr. Robert Meyers and Dr. Jane Ellen Smith. This book teaches the Community Reinforcement Approach Family Training (CRAFT). Our Behavioral Health Advantages also offer counseling to assist family members in using the CRAFT approach. I would also highly recommend participation in the Tri-County chapter of the National Alliance on Mental Illness for family members and friends of persons with mental health problems.
I also wish to offer the opinion that the whole concept of “co-dependency” is bunk. There is no scientific evidence of the existence of this so-called disorder. Personally, I believe it was invented by the chemical dependency field to expand markets and profits. Can drug or alcohol addiction cause stress or depression in a family? Of course, but so can many other factors in relationships.
How does Fayette Companies respond to the needs of businesses?
Our White Oaks programs work with many area employers to provide alcoholism and substance abuse treatment to their employees or employees’ family members. For employed persons, treatment can usually be provided in day or evening intensive outpatient services.
One of our other corporations, Behavioral Health Advantages Inc. (BHA) was established in 1990 to focus on the needs of the business community and of people at work. BHA’s mission, to help organizations manage the human factor at work, is achieved through its four divisions—Employee Assistance Programs, Consultation and Training, Outpatient Counseling and Mediation and Arbitration.
A quality Employee Assistance Program offers employers both a valued employee benefit and an effective management tool. It provides employers with a means of helping valued employees correct performance issues that may be caused by problems in their personal lives. BHA provides training for managers and supervisors to help alert them to the signs of a developing problem and a step-by- step process to help them direct the employee to the help they need. As businesses have increasingly recognized the value and cost-effectiveness of these programs, we have seen considerable growth in this area with BHA providing employee assistance services to 36 companies headquartered in Illinois and to their satellite locations throughout the U.S.
BHA’s Consultation and Training division helps organizations manage the human factor by focusing on the relationship skills that are so important to leadership and team functioning. The Center for Creative Leadership’s research found that three of the four reasons promising leaders were “derailed” related to relationship skills verses job competency. An additional study at Stanford found that of 10,000 people let go from a job, more than 90 percent were fired for interpersonal reasons. BHA consultants can provide organizations with an accurate and objective assessment of the human factor issues present in a department or work group. This assessment, or organizational audit, outlines key themes—group strengths and concerns—and provides recommendations to resolve identified issues. Organizations have found BHA’s consulting services to be extremely helpful in resolving internal conflicts, increasing employee satisfaction and enhancing team effectiveness.
BHA’s Consultation and Training division, working independently and in collaboration with the Leadership Development Center at Bradley University, has provided services to a wide range of organizations (including over 200 Fortune 500 companies) locally, nationally and internationally. BHA’s counseling services also address a wide range of human problems with services for adults, children and families.
What are the potential signs an employer should look for in an employee they suspect may need psychological or substance abuse counseling?
Employers may notice changes in performance: inconsistent work quality, poor concentration, increased absenteeism & presenteeism (at work but not performing), errors in judgment and needless risk taking. And, changes in behaviors: avoidance of friends and colleagues, overreaction to criticism, mood swings, complaints of vaguely-defined illnesses or deterioration in personal appearance. Obviously, this is only a partial list, and the most important factor to take into consideration is change—a previously good performer missing deadlines, an outgoing individual avoiding friends and colleagues at work, an easy-going individual becoming irritable and difficult to approach or a well-groomed employee neglecting his/her appearance.
It is generally believed that 10 percent of a given workforce will experience personal problems, mental health or substance abuse that will have a negative impact on their job performance. The National Institute of Mental Health estimates that one in 20 American adults will be depressed in a given year, and the World Health Organization predicts that major depression will be the second- leading cause of disability by the year 2020. Anxiety disorders affect 29 percent of Americans during their lifetime. Importantly for business, merely moderate levels of anxiety and depression can substantially affect work performance and heath care costs. It is estimated that U.S. employers spend $33 billion per year due to work and productivity loss from depression alone.
Substance abuse also takes its toll in the workplace. While alcohol is clearly the most widely abused substance among working adults, recent studies have shown that 76 percent of illegal drug users are employed.
Understandably, employers who are seldom trained to recognize and deal with mental illness or substance abuse issues are often reluctant to address the problem. Yet highly effective and cost-efficient treatment is readily available for these conditions, and many studies have shown that the vast majority of employees receiving treatment will return to full productivity.
Is the stigma of being in treatment for a mental health disorder diminishing today?
Unfortunately, not by nearly as much as I would hope. A dramatic local example was the closing of the Zeller Mental Health Center four years ago. I was surprised by a constant theme of “where will these people go?” That question demonstrates the misunderstanding of mental illness in the 21st century. In fact, the average occupancy of Zeller was only about 60 people from a 14 county area and the average length of stay was 25 days. Over 90 percent of persons we served who had a serious mental illness never went to Zeller in a given year’s time.
On a positive note, when we initiated a supportive employment program four years ago to help persons with mental health problems obtain competitive employment, I was extremely impressed with the receptivity of employers. The vast majority of employers we contacted indicated not only a willingness to employ persons with a history of mental illness but also took a proactive approach. Several asked that potential applicants attach the business card of our job developer to applications so they could flag these individuals for special consideration. The project has been extremely successful with 45 percent of persons in the service finding employment compared to 10 percent finding employment in national studies of the population with a serious mental illness. I believe employment is a key foundation of recovery and have set a five-year goal of obtaining at least a 50 percent employment rate for persons with a serious mental illness. I encourage any employer who is interested in supporting recovery through employment to contact me.
What would you like our readers to know that has not been asked?
That recovery can only occur in the community and with the support of the community. Sure, some people need psychiatric hospitalization or residential addiction treatment due to the severity of their symptoms, but true recovery cannot occur in an institution. Unfortunately, in most communities the services are fragmented rather then integrated. A person with mental illness, substance abuse problems and physical health issues has little or no chance of receiving integrated care.
In the Peoria area, we have been trying to overcome this silo system for the last four years through the Central Illinois Coalition for Mental Health Recovery. This group was originally formed by State Representative David Leitch when the closing of Zeller was announced. Over the years, membership has expanded to more than 40 organizations that meet monthly. A steering committee meets with Representative Leitch weekly to conduct more detailed planning. Service gaps are identified through flowcharting the mental health service system for both youth and adults. The group then plans how to fill these gaps, pursuing new resources as needed. The work of this group to develop and support a recovery- oriented system of care has gained statewide recognition. IBI
