ITHACA, NY – The Tompkins County Mental Health Clinic will be adopting a new care model known as Personalized Recovery Oriented Services, or PROS, in May.

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A presentation at the Tompkins County Health Department on Monday discussed the emerging needs for mental health care in the county.

David Shapiro, president and CEO of Family & Children’s Service of Ithaca began the discussion by sharing some statistics. According to Shapiro, roughly 20 percent of people nationwide suffer from some form of mental health issue.

Applying that to Tompkins county, that means around 20,000 out of the county’s 100,000 may need mental health care. Shapiro said that Family & Children’s serves around 2,000 — and while his obviously isn’t the only mental health care service in Tompkins, he expressed doubt that a potential 18,000 additional people were being served.

Shapiro said that even as his organization continues to expand services, it seems like its not making a dent in the actual demand.

“It seems to me like whenever we hire a new clinician, we actually have the need for two. As we’ve built new office, as we’ve built new off-site locations, our waiting list continues to grow,” Shapiro said. “It’s shocking on one hand, and its very troubling to think that there are so many people in need.”

Tompkins County Mental Health Program Director Joseph Lyman also shared some troubling stats. According to Lyman, suicide is the 10th leading cause of death in the country, and people with severe mental illness have an average lifespan 25 years shorter than the general population, in some cases because mental health issues prevent a person from seeking care for their physical health.

The PROS model

Lyman outlined how the PROS approach differs from traditional mental health care models as a more person-centered, recovery-oriented model.

Lyman framed it as difference between treatment and rehabilitation. Many traditional methods of mental health care focused on primarily on symptom management, but failed to address the bigger picture. Lyman discussed how previous approaches to mental health care, like day programs, ultimately always ended up isolating patients, whereas PROS seeks to connect people with peer and community networks.

The analogy that Lyman used is that where day programs are like high school, the PROS approach is more like college. Rather than the program setting goals for a patient to meet, the PROS approach lets the patient set their goals and then finds ways to help them reach those goals.

Lyman gave an example: “A case it might be: ‘I want a relationship.’ How do we help people build relationship skills and make healthy decisions around relationships? It could be: ‘I want to be involved in my community.’ Let’s break that down. What does that look like?”

“PROS shouldn’t be the community. PROS shouldn’t be a place where we have folks segregated. We might be a vehicle for people who don’t have social connections in our community to come learn skills and then we can bridge them out,” Lyman continued. “One of the neat things about PROS is that we’re not confined by our walls. The model for PROS allows us to go out in the community with our people and help them connect on their own.”

According to the New York State Office of Mental Health, there are four components of the PROS model: Community Rehabilitation and Support (CRS), Intensive Rehabilitation (IR) and Ongoing Rehabilitation and Support (ORS). Lastly, Clinical Treatment (CT) is an optional element of the program.

  • The CRS component includes services designed to engage and assist individuals in managing their illness and restoring those skills and supports necessary for living successfully in the community.
  • The IR Component is composed of four different services. Through Intensive Rehabilitation Goal Acquisition, services are designed to assist an individual to attain a specific goal within a certain area, such as education, housing or employment. IR may also be used as Intensive Relapse Prevention to provide targeted interventions to reduce the risk of hospitalization or involvement in the criminal justice system. In addition, IR includes two evidence-based practices: Family Psychoeducation and Integrated Dual Disorder Treatment (IDDT).
  • The ORS component provides supports to assist individuals in managing their symptoms in the competitive workplace, similar to the services provided by Challenge Workforce Solutions.

Another advantage of PROS is that is essentially an a-la-carte program: a patient can enroll in as many or as few elements of the PROS model as they like. Similarly, if a patient only feels they need clinical treatment, they do not have to enroll in any PROS programs.

Similarly, PROS can be a supplement to the services of an independent mental health care provider, and according to Lyman there will be no issues with double-billing or funding conflicts from insurance companies and the like.

Lyman explained that the PROS approach is more open. Whereas day programs often have a requirement for more serious mental health conditions, getting help through the PROS program has only two requirements: be an adult and have an official mental health diagnosis that is impacting your life in some negative way, be it personal relationships, school, work or otherwise.

Additionally, the PROS program is designed to help people with dual diagnoses, such as substance abuse issues. While the old standard for some mental health care programs was to require a person to “get clean” before enrolling, the PROS approach has no such restriction, and includes in-house services to help people deal with addiction.

The program also includes elements of harm reduction, which are public health policies designed to limit the harm of risky or illegal activities such as alcohol and drug abuse.

Lyman said that the new program will be rolled out in May, with the first six to eight weeks being focused on transitioning people currently engaged in programs through the Tompkins County Mental Health Clinic over to the PROS model.

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Michael Smith

Michael Smith reports on politics and local news for the Ithaca Voice. He can be reached via email at, by cell at (607) 229-0885, or via Google Voice at (518) 650-3639.