July 07, 2006

SAMHSA Issues Consensus Statement on Mental Health Recovery

Thank you to Dan (danweb) for posting this in the News Forum.

SAMHSA (Substance Abuse & Mental Health Services Administrator) put out a press release last February with what they believe to be the 10 Fundamental Components of Recovery.

After reviewing the Fundamentals below, you can clearly see they lack the ability to truly help the entire population with mental illness. In fact, the people with the most severe disorders are not properly accounted for. These fundamentals are based on the idea that all patients known they have a mental illness, and are consistently able to see they need help (through medications, supervision, and therapy). Anyone who knows someone with Schizophrenia or Bipolar Disorder, to name a few, knows that there may be times when they are not fully aware they need help (Anosognosia).

See A Statement of Madness, a perspective by Dr. Sally Satel, a psychiatrist and scholar at American Enterprise Institue on these new fundamentals from SAMHSA.

10 Fundamental Components of Recovery:

• Self-Direction: Consumers 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. By definition, the recovery process must be self-directed by the individual, who defines his or her own life goals and designs a unique path towards those goals.

• Individualized and Person-Centered: There are multiple pathways to recovery based on an individual’s unique strengths and resiliencies as well as his or her needs, preferences, experiences (including past trauma), and cultural background in all of its diverse representations. Individuals also identify recovery as being an ongoing journey and an end result as well as an overall paradigm for achieving wellness and optimal mental health.

• Empowerment: Consumers have the authority to choose from a range of options and to participate in all decisions—including the allocation of resources—that will affect their lives, and are educated and supported in so doing. They have the ability to join with other consumers to collectively and effectively speak for themselves about their needs, wants, desires, and aspirations. Through empowerment, an individual gains control of his or her own destiny and influences the organizational and societal structures in his or her life.

• Holistic: Recovery encompasses an individual’s whole life, including mind, body, spirit, and community. Recovery embraces all aspects of life, including housing, employment, education, mental health and healthcare treatment and services, complementary and naturalistic services (such as recreational services, libraries, museums, etc.), addictions treatment, spirituality, creativity, social networks, community participation, and family supports as determined by the person. Families, providers, organizations, systems, communities, and society play crucial roles in creating and maintaining meaningful opportunities for consumer access to these supports.

• Non-Linear: Recovery is not a step-by step process but one based on continual growth, occasional setbacks, and learning from experience. Recovery begins with an initial stage of awareness in which a person recognizes that positive change is possible. This awareness enables the consumer to move on to fully engage in the work of recovery.

• Strengths-Based: Recovery focuses on valuing and building on the multiple capacities, resiliencies, talents, coping abilities, and inherent worth of individuals. By building on these strengths, consumers leave stymied life roles behind and engage in new life roles (e.g., partner, caregiver, friend, student, employee). The process of recovery moves forward through interaction with others in supportive, trust-based relationships.

• Peer Support: Mutual support—including the sharing of experiential knowledge and skills and social learning—plays an invaluable role in recovery. Consumers encourage and engage other consumers in recovery and provide each other with a sense of
belonging, supportive relationships, valued roles, and community.

• Respect: Community, systems, and societal acceptance and appreciation of consumers —including protecting their rights and eliminating discrimination and stigma—are crucial in achieving recovery. Self-acceptance and regaining belief in one’s self are particularly vital. Respect ensures the inclusion and full participation of consumers in all aspects of their lives.

Responsibility: Consumers have a personal responsibility for their own self-care and journeys of recovery. Taking steps towards their goals may require great courage. Consumers must strive to understand and give meaning to their experiences and identify coping strategies and healing processes to promote their own wellness.

Hope: Recovery provides the essential and motivating message of a better future— that people can and do 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.

Sally Satel's criticism of these principles are partially expressed in this quote:

"The problem with the recovery vision is that it is a dangerously partial vision. It sets up unrealistic expectations for those who will never fully "recover," no matter how hard they try, because their illness is so severe and their dependence on medications so great. By neglecting the needs of the most severely ill — that is, the individuals whose very awareness of being sick is blunted — the Consensus recovery guidelines are applicable to only half of those with mental illness. Picture the outrage that would be aimed at the National Cancer Institute if it sent out "recovery guidelines" on breast cancer that ignored half the clinical population of women with the disease.

What's more, exclusive emphasis on recovery as a goal steers policymakers away from making changes vital to the needs of the most severely disabled."

SAMHSA Press Release:

Articles of Interest:
Mandated Treatment In the Community for People with Mental Disorders, Mental Health Law, Sept/Oct 2003.

National Consensus Statement on Mental Health Recovery



Posted by: Tim at July 9, 2006 10:05 AM

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