Mental health care and recovery

Five years ago this week, the federal government embraced a consensus statement on the approach to mental health known as the recovery model. It stresses patient autonomy and quality of life, instead of merely controlling symptoms.
From WHYY’s Behavioral Health desk, Maiken Scott takes a look at the recovery movement, its successes and controversies.

Five years ago this week, the federal government embraced a consensus statement on the approach to mental health known as the recovery model. It stresses patient autonomy and quality of life, instead of merely controlling symptoms.

From WHYY’s Behavioral Health desk, Maiken Scott takes a look at the recovery movement, its successes and controversies.

View our Digest This web discussion on Mental health and recovery.

Listen:

[audio:091214msrecovery.mp3]

At the recovery and education center in South Philadelphia, people are sitting around a table, interviewing a potential new therapist. Some are staffers:

sound: …you have individual therapy experience …

But others are consumers who use the center’s services:

sound: What would you say your strengths are?

This scenario would have been unthinkable even a decade ago, says Dr. Arthur Evans, who heads Philadelphia’s department of behavioral health:

Evans: The magnitude and the gravity of the changes we are trying to make in the field are really significant. They affect how we finance services, and how we organize services, and how we develop programs and what our relationship is to the people we serve.

For decades, says Evans, treatment had been about controlling symptoms, through various drugs and therapies. Now, behavioral health programs seek to help people with mental illness address a host of connected issues: how to live independently, hold onto a job, run a household, connect with others. For example, the city has changed what it calls its partial hospital programs, essentially day care for people with severe mental illness:

Evans: They came to these programs every day, picked up by a van, brought to the program, and then taken home. Literally in that pattern for many years.

Now says Evans, the programs seek to teach patients how to get to the next level of autonomy:

Evans: The staff changed their roles to being coaches, facilitators, helping people to get jobs, helping people using public transportation.

Living and working in the community is one of the key components of the recovery model.

Mark Salzer heads the University of Pennsylvania Collaborative on Community Integration. He says identifying what’s keeping people from participating is an important first step:

Salzer: For people with mobility impairments, curbs used to be a major impediment, and for people with psychiatric disabilities, stigma and discrimination are major barriers.

Curbs may be a superficial problem, but prejudice against people with mental illnesses continues to run deep, Salzer says:

Salzer: We have research evidence that there is ample discrimination in employment settings, in educational settings, in interpersonal relationships.

Providers are beginning to practice what they preach by hiring people with mental illnesses. This has helped fuel a boom in what are called as certified peer counselors. Getting counseling from people who’ve been there and done that is another cornerstone of the recovery approach. Take Robert Martin for example – a counselor who was once a homeless drug addict with a long history of mental illness:

Martin: People come to me and tell me their dreams, and their aspirations, and what they want to get back in life. And I support them with that, I walk along side of them, I don’t walk in front of them, I don’t walk behind them – we walk hand in hand.

Treating people with respect and dignity is the reason Martin says recovery-based treatment works for him:

Martin: They deal with me as Robert Martin, not Mr. Bipolar, or Mr. Schizophrenia, or Mr. Substance Abuse, I’m not a diagnosis.

The focus on consumer autonomy is a point of friction with skeptics who question this aspect of recovery model.

Schwartz: What is the doctor or clinician to do when a patient makes a very very wrong decision?

That’s psychiatrist Harold Schwartz of the Institute of Living in Connecticut.

He says if doctors step in and mandate treatment, it diminishes the patient’s autonomy – but:

Schwartz: The failure to treat makes it more likely that relapses will occur and the patient will go on to a lifetime of chronic illness.

Schwartz accepts many core tenets of the recovery approach, but is worried that the governmental embrace of recovery may be a way to put a consumer-friendly face on budget cuts in mental health programs.

Schwartz: We live in a world of tight resources, and if resources are going to be placed into programs that really aren’t proven, and if that is at the expense of evidence based therapies, then I believe that is at the expense of the patient.

Mark Salzer says in order for the recovery model to deliver on its promise, policy has to go beyond lip service:

Salzer: There also is concern that people are adopting recovery as a buzzword, and they will just wrap up old programs in new language.

Salzer says, recovery won’t be possible if government doesn’t help remove barriers to employment and housing.

Listen to Maiken’s interview with Robert Martin, peer counselor for the Recovery and Education Center of Philadelphia: [audio:091214msMartin.mp3]