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The best of Hopeworks: On recovery as the mission of the mental health system

Posted Jul 24 2012 5:02am

(This post is largely based on the work of Dr. William Anthony who writing over 20 years ago was still well ahead of our times.)

In a small essay entitled, “Recovery from mental illness:  The Guiding Vision of the Mental Health System of the 1990′s”,  written over 20 years ago Dr. William Anthony layed out the dimensions that needed to be addressed in a truly recovery oriented system.  He was optimistic.  Those dimensions describe areas still needing much improvements in 2012.  The system he describes is not the same as  what the ordinary person involved in the mental health system experiences.  In fact for many involved in the public mental health the system Anthony describes is almost the opposite of what they experience.

Symptom relief:  These are those things which help to manage or alleviate symptoms and decrease distress.  For many people this is all the mental health system should be concerned with.  It is only the smallest part of what recovery is really about.

Too often what the average consumer has access to simply doesnt always give much relief.  Medication is a trial of its own.  While it does help many, for many it does not.  Sometimes it takes years of trials to find a dose that seems to help.  For many that magic dose is never found.  For everyone rather they are helped or not there is a real issue of side effects that may pose life altering or life threatening conditions on them.

Many people for example see to assume that something like “dry mouth” is an irritant that people will learn to live with.  Google health effects of “dry mouth” and you will be astounded.  Literally millions of people can attest to the fact that being diagnosed with a mental illness means a lifetime of dental problems and often a mouth of rotten teeth.  Other effects like diabetes, weight gain, heart problems and others are obviously even more dangerous.

For many people the emphasis on psychotropic medication is balanced by the lack of adequate counseling or therapeutic activities.  A system people poor often survives by being pill rich.

Another major experience of people in the mental health system is that of psychiatric hospitalization.  If you judge it based on almost any criteria I know it simply doesnt work and leaves people emotionally bruised and battered.  It gives them a message about what kind of people  they are that hurts in the long run as much as anything helps in the short run.

Personal safety assured:  This is the ability to resolve critical situations successfully.  It means crisis resolution that does not retraumatize already traumatized people.  It is more than simply finding the way to hospitalize people.  It means the system into which they are being placed is also safe.  Again ask anyone who has been there how safe they have felt.

Personal survival insured:  This means providing access to things like food, clothing, housing, and medical care that is essential to survival.  The experience of countless people diagnosed with mental illness  is that all these things are problematic for them.

Access to needed services:  People have the access to the services the need.  The reality is simple.  If you are poor, if you have no or limited insurance you dont.

Role functioning:  People are taught the skills they need to be successful in their life.  This comprises a wide range of possible skills but includes interpersonal skills, self management skills, decision making skills and many other.  It means helping people to have a real chance at success.

Self development:  This means involving people in experiences that confirm them and give them a sense of personal satisfaction.  It means more than helping people to do well, but in helping them to find a sense of meaning and purpose in what they do.

Empowerment:  This means that people learn to develop their own sense of voice in life.  It means that people learn that they have a choice in life and what they choose matters.  For many people this is exactly what their experience in the mental health system destroys.  It doesnt build independence.  It leaves the m mired instead in a deepening cycle of dependence.

Equal opportunity:  This is the experience of learning to stand up for themselves and their rights.  Much of the experience of mental illness is in the opposite.  It is in being exposed to stigma on every level of your life.

Health:  People with a mental health diagnosis die years earlier than those without.   The importance of a healthy lifestyle is integral to any experience of recovery.

On a scale of 1-10 then rate your experience of the mental health system:

  • Helps decrease disabling conditions.
  • Insures safety at critical times.
  • Helps to meet survival needs
  • Allows access to needed services.
  • Increases abling conditions
  • Helps develop a sense of meaning and purpose in life.
  • Helps develop a sense of empowerment and autonomy in life..
  • Helps to advocate for rights and fair treatment.
  • Helps promote a healthy lifestyle.

As Anthony wrote over 20 years ago these are the dimensions of a recovery based system.  Recovery should be the mission of the mental health system.  But to what degree is that the everyday experience of those that use it?


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