To clearly define recovery, the Substance Abuse and Mental Health Services Administration within the U.S. Department of Health and Human Services and the Interagency Committee on Disability Research in partnership with six other Federal agencies convened the National Transformation in December 2004, 110 expert panelists participated including people with lived experience and advocates. One development of this meeting was a document entitled, “10 Fundamentals of Recovery”.
Self-directed: Persons with mental health issues lead, control, exercise choice over, and determine their own path of recovery by optimizing autonomy, independence, and control of resources to achieve a self-determined life. To access inner knowledge of self takes time and patience, but they can learn or improve abilities, listen to themselves and determine what is best and right for them.
Providers are using “Motivational Interviewing” which not only determines where a person is in recovery, but helps them to meet that person where they are and help them to discover and access their inner knowledge and determine their own strengths and resiliencies.
Individualized and Person Centered: There are multiple pathways to recovery based on an individual’s unique strengths and resiliencies as well as is/her needs, preferences, experiences (including past trauma), and cultural background in all of its diverse representations.
Individuals need education, tools and support to believe they are capable of reclaiming their lives. Educational tools include journaling, medication logs, W.R.A.P.,, Wellness (Ilness) Management and Recovery groups, and other workbooks specific to aspects of living with and managing a mental illness. Peer support groups are available in many communities.
Empowerment: Empowerment is the belief that one has power and control in their life. Individuals need education, tools and supports to believe they are capable of reclaiming their lives. They might require mentoring to learn how to self-advocate for their rights. Community supports might include W.R.A.P. groups, Wellness (Illness) Management an Recovery groups, NAMI Peer to Peer classes and workbooks specific to aspects of living with and managing a mental illness and the system that provides services to them. There are also networks and forums set up for people to connect with each other and share experience and strength.
Holistic: Recovery encompasses an individual’s whole life, including mind, body, spirit and community. This would include the issues of housing, employment, education, mental health and healthcare treatment and services, complementary and naturalistic services, addictions treatment, spirituality, creativity, social networks, community participation, and family supports as determined by the person. Peer, community and social supports play crucial roles in creating and maintaining meaningful opportunities for people to access services and knowledge.
Services are now looking at someone as a “whole” person, focusing on all seven domains in a person’s life (e.g.: cultural/ethnic factors, spiritual and religious beliefs, medical issues, housing, financial, etc.) Persons who struggle with multiple occurring problems (mental health, addictions, developmental and physical disabilities) are now encountering a system that is transforming and willing to look at these issues together, in collaboration, to ensure the fullest healing possible.
Non-linear: The acknowledgement that recovery ebbs and flows, just like life ebbs and flows, is crucial to the acceptance needed to continue on the recovery journey and build resiliency. People learn to reframe experiences, to look at life differently. “Failures” become “learning experiences”, “struggles ” become “challenges”.
The old medical model focused on overcoming “deficits” or symptoms. The recovery model now focuses on overcoming “challenges” to recovery. “Treatment” plans are now “Recovery” plans in which strengths are being emphasized. The Centers for Medicare and Medicaid Health Services (CMHS) has called for a change to Person Centered Recovery plans.. Strengths include: values and tradition, interest, hopes, dreams, aspirations and motivation; resources and assets, both monetary/economics, social and interpersonal; unique individual attributes (physical, psychological, performance capabilities, sense of humor, etc.); circumstances in the community that have worked well in the past and “natural supports” within the community. Once strengths have been identified, the person and their team can explore where in the “real world” these attributes can be shared, appreciated and reciprocated and where the person’s contributions and social roles will be valued.
Peer Support: Mutual support, including the sharing of experiential knowledge and skills and social learning, plays an invaluable role in recovery. People are encouraged and engaged with others in recovery and provide each other with a sense of belonging, supportive relationships, valued roles, empowerment and community. Peer support groups have been operating under this premise for some 70 years
Other steps toward peer support have been encouraged and financed in the mental health system. Peer Run Organizations and Peer Support Specialists are now being integrated into mental health services, paid for through mental health block grant and Medicaid funding. A Peer Specialist is a trained and certified individual, with lived experience, whose primary responsibility is to help those they serve achieve self-directed recovery, advocating for full integration of those individuals into the communities of their choice.
Respect: Self-acceptance and regaining belief in one’s self are particularly vital. Respect ensures the inclusion and full participation of people in all aspects of their lives.
In an atmosphere of respect, there has to be unconditional acceptance of each person, as they are, including acceptance of diversity with relationship to culture, ethnicity, language, religion or spirituality, race, gender, age, disability, sexual orientation and/or “readiness” issues. This means meeting every person precisely where they are on their journey.
Responsibility: Recovery oriented relationships are based on clearly defined , mutually agreed upon shared expectations and responsibilities of all persons involved. The concept of “power” is dissolved. Decisions are made by collaboration of the parties and not by the system and its expectations. This directly relates to person centered planning. The Recovery Implementation Task Force of Wisconsin has developed a “Consumer/Provider” contract which spells out the general responsibilities of the parties involved. It has been implemented in services with very positive results. Old practices clearly have shown, without a doubt that compliance does not work. Current evidence based practices clearly show that collaboration does. In collaboration, a person takes action on behalf of themselves to promote their own recovery. They take responsibility for their recovery.
Hope: Recovery provides the essential and motivating message of a better future that people and, do, and will, overcome the barriers and obstacles that confront them. Hope is internalized; but can be fostered by peers, families, friends, providers, and others. Hope is the catalyst of the recovery process. Mental health recovery not only benefits individuals with mental health issues by focusing on their abilities to live, work, learn, and fully participate in our society, but also enriches the texture of American community life.
Hope is a desire accompanied by confident expectation. Fostering hope is the foundation for on- going recovery. Even the smallest belief that things will get better can fuel the recovery process. Hope is the element that binds our recovery and the 10 fundamentals. Early in the recovery process, it is possible for a provider, friend and/or family member to carry the hope for a person. At some point, however, the person must develop and internalize their individual sense of hope.
Here in Wisconsin, we have integrated these 10 recovery principles into trainings given to consumers, professional staff and community organizations. Trainings are taught by Peers and Professionals, side by side. Person Centered Planning is being used in every venue of the public mental health system. A transformation is taking place here from focus on the medical model to the recovery model. Medicaid billing now includes psychosocial education and Certified Peer Specialist Services. 16 Consumer Champions train staff statewide on Trauma Informed Care. Evidence based practices are being encouraged and rewarded in the system. Consumers have been brought to every level of decision making in the process. Consumer Run Organizations organized 12 Recovery Centers that are funded with mental health block grant funds and more are being envisioned by the state. We, the consumers of Wisconsin are truly a part of this transformation process and our voice IS being heard.
Alyce M. Knowlton-Jablonski is the Executive Director of the Wisconsin Association of Peer Specialists, Inc. She works part-time as an Advanced Certified Peer Specialist in the Community Comprehensive Services program at North Central Health Care in Wausau, WI. She is involved in NAMI at the state and local level . She is active in Grassroots Empowerment Project as a Regional Network Leader. She has been involved in the system transformation in Wisconsin since 1996, beginning with the Governor’s Blue Ribbon Commission and currently serves as on the Wisconsin Recovery Implementation Task Force and Trauma Informed Care Advisory Committee. Alyce has presented Recovery and Person Centered Planning as part of a state of Wisconsin training team and has presented at many conferences/summits on mental health recovery, dual recovery, person centered planning, peer specialist services and the stages of mental health/AODA recovery.