Magazine article Behavioral Healthcare Executive

Time to Stop Being One-Dimensional: We're Focused on Disease While Neglecting Health

Magazine article Behavioral Healthcare Executive

Time to Stop Being One-Dimensional: We're Focused on Disease While Neglecting Health

Article excerpt

For the past three score years, we in the mental health and substance use care fields have been "one-dimensional" people: We have focused only on disease and its remediation. Our efforts have produced exquisite classification systems for disease and its treatment, and our language has evolved apace: first "schizophrenic," then "patient," and now "consumer."

This one-dimensional focus has blinded us to a much broader universe of possibilities, including the world of health. We really have no corresponding classification system, interventions, or language to reflect mental and addictive health. In the late 1940s, the World Health Organization (WHO) defined health as "a complete state of mental, physical, and emotional well-being." We need to revisit this concept so that we can begin to apply it in our day-to-day work.

In fact, consumers have been trying to alert us to this second dimension for decades. By endorsing and promoting the concept of recovery, consumers indirectly introduced the health dimension to us. Recovery encompasses new hope, positive affect, and future possibilities. Hence, I think recovery can be thought of as a bridging concept between the dimensions of disease and health (figure).


This second dimension (health) clearly can foster a world of new possibilities for consumers with mental and substance use conditions. They can become integrated into their support networks and communities; they can begin to live. It also can open up a whole new world for all of us who work in these fields. This dimension accentuates the positive, and it can change the practices employed throughout our fields.

National health reform (repeat, health reform) will focus not only on healthcare but also on health promotion and the determinants of positive health, Because our current, exclusive focus on disease does not work well, yet is very costly, we can expect that reform legislation will target resources on personal and population health promotion, as well as related interventions and measurement systems. We need to be ready for these important changes.

We should pause and ask ourselves several important questions: What research do we have on the shelf regarding interventions that promote mental and addictive health? Which of these interventions have been implemented in our fields? What outcomes have been achieved? A moment's reflection will tell us that the answer to these questions is generally none! …

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