Academic journal article Human Organization

"An Old Way to Solve an Old Problem": Provider Perspectives on Recovery-Oriented Services and Consumer Capabilities in New Mexico

Academic journal article Human Organization

"An Old Way to Solve an Old Problem": Provider Perspectives on Recovery-Oriented Services and Consumer Capabilities in New Mexico

Article excerpt

The goal of recovery has emerged as a core value in the reformation of public and private mental health services in the last twenty years. However, definitions of recovery remain as varied as methods of implementation. Through an ethnographic lens, we examine meanings of recovery in the context of a major statewide reform of mental health services in New Mexico, focusing specifically on provider-voiced concerns regarding recovery and recovery-oriented care. We argue that the concept of recovery functions as a symbol that seemingly reconciles the long-standing tension between biological and social explanations of mental illness. Drawing upon provider perspectives, we also discuss concerns that popular rhetoric about recovery may mask some needed fundamental changes to transform the mental health system to a recovery orientation. Finally, we consider recovery from a capabilities standpoint and discuss how this view lends itself to addressing both individual and social components of mental illness.

Key words: recovery, serious mental illness, health care reform, New Mexico

Introduction

In July 2005, the State of New Mexico launched a major 1 0-year overhaul of its ailing public mental health system. To reduce costs and increase efficiency and consistency in services, the state initiated a process to "blend" and "braid" all public funding for mental health and substance abuse treatment.1 The fifteen state agencies that had administered these funds agreed to work collaboratively to plan and oversee an integrated system. Rather than only including the largest purchasers of mental health care, New Mexico also involved state agencies that could play vital roles in delivery of other relevant services, such as those specializing in employment, housing, and transportation. A single managed care company, ValueOptions, was then selected to administer services. In response to federal calls for recovery-oriented care and outcomes, the architects of this reform stated that services in the transformed system would focus explicitly on consumer recovery (Hyde 2004).2

During the early stages of reform, the emphasis on recovery was enthusiastically embraced by consumers, advocates, managed care employees, and state government officials. The optimistic language of "hope," "fulfillment," and "empowerment" associated with recovery both in New Mexico and throughout the nation united such diverse stakeholders behind the goal of societal integration for individuals with serious mental illness (SMI), including schizophrenia, major depression, and bipolar disorder.

We conducted in-depth interviews with mental health providers in New Mexico, a predominantly rural and economically-challenged state that has undergone three major shifts in the delivery of publicly funded services since 1997 (Willging, Waitzkin, and Nicdao 2008; Willging, Waitzkin, and Wagner 2005). Each shift extended the penetration of managed care within the public sector. The first two shifts promoted the free-market goals of competition, efficiency, and cost cutting through the privatization of Medicaid services. Here, the state government contracted with multiple managed care companies to contain costs and oversee service delivery to low-income individuals. The move to managed care resulted in several adverse impacts for providers, e.g., administrative burdens and payment problems, and contributed to the closing of mental health programs throughout the state. The most recent reform has extended the purview of managed care to all publicly funded mental health services. In contrast to the two previous shifts, in which the logics of neoliberalism were enthusiastically embraced by state officials, the current reform departs from the earlier of narrative of privatization and cost containment and has instead heralded the development of a system of care that will support "recovery" and "resiliency" among persons with debilitating psychiatric illnesses.

In 1997 - five years prior to the initiation of the most recent reform in New Mexico - the State of Wisconsin launched its own ambitious initiative to introduce managed care and simultaneously transform the public mental health system toward a recovery orientation. …

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