Magazine article Behavioral Healthcare Executive

Are Recovery Services Just a Fad? Some Experts Question Whether Recovery-Oriented Care Can Fulfill Its Promises

Magazine article Behavioral Healthcare Executive

Are Recovery Services Just a Fad? Some Experts Question Whether Recovery-Oriented Care Can Fulfill Its Promises

Article excerpt

Everywhere you turn, you'll find people in behavioral healthcare talking about recovery. From the halls of a local community mental health center to meeting rooms on Capitol Hill, the push for recovery-based services has become an important force in behavioral healthcare. While provider and consumer buy-in of recovery appears strong, some are expressing concerns about the concept.

To start with, recovery is not a clear-cut idea, and many definitions exist. The federal government relied on more than 110 experts to develop this consensus statement: "Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential." (1)

Complicating the notion of recovery, recovery means different things for different mental health consumers. Larry Davidson, PhD, and colleagues report in the May issue of Psychiatric Services that recovery for one consumer might mean recovering from a mental illness over a long period, while for others recovery is more about having the right to self-determination and community inclusion than clinical or functional status. (2)

Such ambiguity leads Faith B. Dickerson, PhD, MPH, to consider recovery a "fuzzy concept." Dr. Dickerson, director of psychology at Sheppard Pratt Health System in Baltimore, says that when consumers hear "recovery," they often think "cure," and that is hardly the end result for many patients. "Mental illnesses are highly disabling, and, as recent reviews have emphasized, our science has not come even close to being able to cure or prevent them," she writes in the May issue of Psychiatric Services. (3) One of those reviews was led by Thomas R. Insel, MD, director of the National Institute of Mental Health, who writes with a colleague in Molecular Psychiatry, "Even with optimal care, many patients with mental illness will not recover, where recovery is defined as permanent remission." (4)

Although she appreciates the energy and enthusiasm that the concept of recovery has brought to the field, Dr. Dickerson suggests providers would be better advised to rely on evidence-based treatments that have been proven to be effective in relieving symptoms, but which have had limited use because of costs, lack of resources, and so on. While Dr. Dickerson is hardly suggesting that the field scrap the recovery model, she does wonder if recovery interventions might distract attention from research-proven treatments, especially because "From my understanding, recovery hasn't yet been linked with evidence-based practices that are focused exclusively on recovery," she told Behavioral Healthcare.

Dr. Davidson and colleagues outline some of Dr. Dickerson's and others' concerns in their article in Psychiatric Services. Taking a cue from the Late Show With David Letterman, they list* the top ten concerns about recovery in serious mental illness they have encountered in trying to implement recovery-oriented services:

10. Recovery is old news. "What's all the hype? We've been doing
    recovery for decades."
 9. Recovery-oriented care adds to the burden of mental health
    professionals who already are stretched thin by demands that
    exceed their resources. "You mean I not only have to care for and
    treat people, but now I have to do recovery too?"
 8. Recovery means that the person is cured. … 
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