Recovery-Oriented Systems of Care
Many behavioral health programs refer to themselves as recovery-oriented, but would an actual person receiving your services agree? If I were a patient at your hospital or clinic or a client of your services, would my experience and the staff leave me believing that I could recover?
Far too often, our system, in the words of the New Freedom Commission Report, “simply manages symptoms and accepts long-term disability.” We do not have a system of care that approaches the individuals it treats as though they can, indeed, recover from or even be in recovery if they have been diagnosed with a serious mental illness.
As a person who is all of those things, I bring a passion to my work focused on ensuring behavioral health professionals are provided accurate information and needed tools to transform their services to a recovery-oriented system of care.
Accurate information. People can and do recover from even the most serious mental illnesses. This has been confirmed repeatedly over more than 40 years of empirical research. If patients don’t know that recovery is possible, they are unlikely to pursue it, let alone achieve it.
As Dr. Dan Fisher says, “Believing you can recover is vital to recovery.” Do you tell people they can get better? Not just from the current episode of depression, mania, anxiety, psychosis… but from the condition itself? Do you give them hope for lasting and true recovery?
While it is true that some people (approximately 25%) diagnosed with serious mental illnesses show deterioration in functioning over time, multiple long-term studies show an equally prominent 25% with “no observable signs or symptoms and no residual impairments from the disorder between 2 and 32 years after onset” (Davidson, 2009). In other words, they recovered from the condition.
The greater majority (45% - 65%) of people with mental health conditions fall along a spectrum of improved outcomes in terms of functioning and symptom levels over time. In other words, they are in recovery. On the whole, then, the experience of recovery in regard to serious mental illness is not only possible, it is probable.
Needed tools. If I could change only one thing in how behavioral health care is handled, it would be in the way we talk to and about the people who receive our services. It doesn’t cost a penny. Everyone agrees that we need more funding in behavioral health, but without one new dollar, we can begin to change lives by changing the way we speak.
It is unfortunately common in the field of medicine to use short-hand in speaking about patients and their medical conditions. He’s asthmatic. She’s diabetic. But when we use similar short-hand in behavioral health, it has unintended and dangerous consequences.
To say “he’s schizophrenic” or “she’s bipolar” can have an awful impact on the person’s sense of self—on their identity—because behavioral health conditions have so much more to do with “who I am” than medical conditions.
If I’m diagnosed with cancer, I know I’m not cancer. If I have foot fungus, I have no doubt in my mind that I’m not foot fungus. But if I’m diagnosed with bipolar disorder, I become bipolar.
But it doesn’t have to be that way. My life changed dramatically when I was told I was not mentally ill. Not that I didn’t have a mental illness. But that I wasn’t it. Before I could recover from it, I first had to learn to separate myself from it, and that started with how I talked about myself.
This concept, known as using person-first language or person-centered language, emphasizes the person first, before the diagnosis. Using person-first language in behavioral health is clinically correct: Your patient isn’t bipolar. He or she has bipolar disorder.
This simple (and free) change not only helps the individual maintain, or regain, a healthy sense of identity separate from the mental health challenge, it also helps the behavioral health provider to consistently remember that they are treating a person, first.
Consider this and other tools that you can use to begin to transform your services to becoming truly recovery-oriented. Because if I were a patient at your hospital or clinic, or a client of your services, I would be counting on you to help me remember that recovery is not only possible, but probable.
- Davidson, L., Tondora, J., Lawless, M., O’Connell, M., Rowe, M. (2009). A Practical Guide to Recovery-Oriented Practice: Tools for Transforming Mental Health Care. Oxford University Press.
- Department of Health and Human Services (2003). Achieving the Promise: Transforming Mental Health Care in America. President’s New Freedom Commission. Final Report (DDHS Pub. No. SMA-03-3832).
- Fisher, Daniel. Believing you can recover is vital to recovery from mental illness (2013). http://power2u.org/articles/recovery/believing.html
- Mental Health America. Person-Centered Language (2016). http://www.mentalhealthamerica.net/person-centered-language