Recovery-oriented Systems Of Care Research Articles

Recovery-Oriented Systems of Care

As a result of the Institute of Medicine's Quality of Health Care in America project, performance and outcome measures have been established to evaluate current approaches to treatment. Although th...

Recovery and Public Policy: Driving the Strategy by Raising Political Awareness

In both Scotland and England, recovery has emerged as a key concept in public policy and has informed the national strategies in each country. This high-level commitment has provided a major opportunity for the establishment of „recovery-oriented systems of care” in each country but with differences in both the content of the policy and in the mechanisms for implementation. This article discusses questions around implementation and the issue of time scales, with implications for changing cultures and practices in provider agencies and commissioning practices at a local level. Much of this debate concerns attempts to operationalize „recovery” at an individual level and to create meaningful measures of recovery process and outcome. The overview and discussion component will review the challenges faced in attempting to translate recovery policy at a national level into meaningful systems at a local level and the likely impact this will have on individuals and communities attempting to initiate their own reco...

Recovery-Oriented Systems of Care, the Culture of Recovery, and Recovery Support Services

Recovery-Oriented Systems of Care, the Culture of Recovery, and Recovery Support Services

Recovery From Severe Mental Illnesses: Research Evidence and Implications for Practice, Volumes 1 and 2

Back to table of contents Previous article Next article Book ReviewFull AccessRecovery From Severe Mental Illnesses: Research Evidence and Implications for Practice, Volumes 1 and 2Yad M. Jabbarpour M.D.Yad M. Jabbarpour M.D.Search for more papers by this authorPublished Online:1 Aug 2007https://doi.org/10.1176/ps.2007.58.8.1128AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Psychiatry is in an era of change not only in terms of new scientific models of mental health but also in values-based models of psychiatric service. Our nation's first two commissions on mental health were appointed by President Kennedy in 1963 and by President Carter in 1978. The third commission, the New Freedom Commission appointed by George W. Bush, sets a vision for recovery in its budget-neutral document, Achieving the Promise ( 1 ). "Recovery" is becoming more than a word. It is a possible juggernaut of hope and transformation. This two-volume set on recovery, published by Boston University's Center for Psychiatric Rehabilitation, was edited by three doctorate psychologists, Larry Davidson, Courtenay Harding, and LeRoy Spaniol, experts in the field of psychosocial rehabilitation with experience as researchers, authors, and speakers. The volumes are organized into four main sections. The first is titled, "Recovery From Severe Mental Illness: Is it Possible?" The second section takes the next logical step with the title, "Then What Happens to People Over Time?" The third section, "What Helps People Improve?" is subdivided into a focus on fundamentals of community integration followed by attention to "treatment, case management, and advocacy." The last main section strives to answer the question, "How can mental health systems evolve into recovery-oriented systems of care?" With only four of the scientific articles being new, nearly 80 % are previously published works, dating back to 1979. The volumes total nearly 1,000 pages, and the primary source of articles is the publisher's own Psychiatric Rehabilitation Journal . The editors provide seven additional articles, which are personal accounts and essays that are written mostly by persons with mental illness. These stories and editorials present the reader with a humanistic, subjective set of recitations to complement the previously published, peer-reviewed articles. The last formal chapter provides no personal accounts or articles but is a piece written by the editors on "an agenda for recovery and research." If recovery is a scientific model, then more review could have been invested not only in those areas of the field where recovery easily informs our understanding of illness and outcome but also in areas where recovery has challenges in explaining service provision and certain other phenomena. If recovery is a values-based model, then additional attention to the ethics of recovery or the complex issues of how recovery is balanced by public and personal safety would have helped. Although the discussion addresses varying definitions of recovery, a clearer definition of "severe mental illnesses" in its association with recovery would have enhanced application of the model, as exemplified by the role of recovery in psychiatric illnesses affecting children, adolescents, and older adults. In an era when many persons with mental illness are not only homeless but are being transinstitutionalized into nursing homes, jails, and prisons, more discussion on recovery for persons in these situations would have helped. Historic perspectives would have complemented the model, including similarities of recovery with the efforts of Dorothea Dix and moral treatment of people with mental illness at the turn of the 19th century.Recovery From Severe Mental Illnesses is more than a compilation of research evidence and implications for practice. Each article independently, whether initially published in the British Journal of Psychiatry or Psychiatric Services , might not have provided a full picture of recovery. However, the reader might view these volumes as a refitting of past works that compiles certain pieces of scientific literature from over three decades, cements them together with editorials and personal accounts, and provides a mosaic of a new image and new vision for mental health services. This text will be of interest not only to clinicians and consumers providing services but also to persons with mental illness, their family members, and their advocates. Dr. Jabbarpour is clinical assistant professor at the University of Virginia School of Medicine, Charlottesville, and chief of staff at Catawba Hospital, Catawba, Virginia.Reference1. Achieving the Promise: Transforming Mental Health Care in America. Pub no SMA-03-3832. Rockville, Md, Department of Health and Human Services, President's New Freedom Commission on Mental Health, 2003Google Scholar FiguresReferencesCited byDetailsCited byNone Volume 58Issue 8 August, 2007Pages 1128-1128PSYCHIATRIC SERVICES August 2007 Volume 58 Number 8 Metrics PDF download History Published online 1 August 2007 Published in print 1 August 2007

A Basic Criterion for Transformation

Back to table of contents Next article Taking IssueFull AccessA Basic Criterion for TransformationLarry Davidson Ph.D.,Larry Davidson Ph.D.Search for more papers by this author,Published Online:1 Aug 2007AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail As systems of care take up the challenge of transformation, various perspectives will arise on the desired outcomes of this process. Systems enter the process at different points, with different resources, and with different ideas of what they seek to achieve. This diversity can be useful, as homegrown strategies can be tested, successful approaches shared, and solutions tailored to ever-changing conditions.I am concerned, however, that systems have already begun labeling as "recovery oriented" some services they have been providing for the past 30 years and have introduced as "transformative" new programs that leave much of the existing system intact. This concern is reinforced by the report in this issue by Rogers and colleagues, in which psychiatrists viewed the implications of recovery as limited to increased funding for rehabilitation, not appreciating how all mental health care, including their own practice, needs to be reoriented toward recovery. Such limited changes fall well short of the "fundamental refashioning" called for by the President's New Freedom Commission and risk repackaging old wine in new bottles. To avoid this temptation, perhaps we could achieve a consensus on the bare minimum we need to accomplish before transformation can be said to have occurred. I would like to propose one such minimum criterion.The "promise" we have yet to achieve, to which the title of the New Freedom Commission report refers, was the promise first made a half century ago, that people with mental illnesses would be able to live "in the community in a normal manner." Given that the New Freedom Commission's vision is likewise "a life in the community for everyone," I propose that people do not have a life in the community as long as, and to the degree to which, they remain hospitalized. Having a life in the community should not equate with residing in an institution. Hospitals serve an important function in recovery-oriented systems of care, offering acute care for acute episodes. Since the Olmstead decision, however, hospitals can no longer be considered acceptable places to live. Systems that invest scarce resources in training inpatient staff in person-centered planning, hoping to transform care by offering patients choices of meal times, neglect the fact that most people confined to hospitals would choose to live in the community. Such individuals, who still number in the tens of thousands, need safe, affordable housing options with responsive supports. Although transformation can involve more than this, it should not involve less. As the commission report makes clear, we now know how to afford people a life in the community. Achieving this promise is where and when true transformation will begin. Department of Psychiatry, Yale University FiguresReferencesCited byDetailsCited ByThe meaning of recovery in a regional mental health service: an action research study5 July 2014 | Journal of Advanced Nursing, Vol. 71, No. 1From experience to action in recovery-oriented mental health practice: A first person inquiry26 May 2014 | Action Research, Vol. 12, No. 4Not Just an Individual Journey: Social Aspects of Recovery15 October 2009 | International Journal of Social Psychiatry, Vol. 57, No. 1 Volume 58Issue 8 August, 2007Pages 1029-1029PSYCHIATRIC SERVICES August 2007 Volume 58 Number 8 Metrics PDF download History Published online 1 August 2007 Published in print 1 August 2007

Alcoholism/Addiction as a Chronic Disease

Summary Although characterized as a chronic disease for more than 200 years, severe and persistent alcohol and other drug (AOD) problems have been treated primarily in self-contained, acute episodes of care. Recent calls for a shift from this acute treatment model to a sustained recovery management model will require rethinking the natural history of AOD disorders; pioneering new treatment and recovery support technologies; restructuring the funding of treatment services; redefining the service relationship; and altering methods of service evaluation. Recovery-oriented systems of care could offer many advantages over the current model of serial episodes of acute care, but such systems will bring with them new pitfalls in the personal and cultural management of alcohol and other drug problems.