Magazine article Behavioral Healthcare Executive

Recovery: The Bridge to Integration? Part One

Magazine article Behavioral Healthcare Executive

Recovery: The Bridge to Integration? Part One

Article excerpt

During the late 19th century, conflict flourished between leaders of the Association or Medical Superintendents of American Institut ions For the Insane and leaders of the American Association for the Study and Cure of Inebriety. Members of both groups represented institutions and practitioners plagued by the confluence of addiction and mental illness. Chicken or egg arguments on the relationship between the two types of disorders abounded, as did debates about cultural/professional ownership of the most intractable clients and their appropriate diagnosis and treatment.1,2

From this inauspicious beginning, an uneasy relationship between the addictions and mental health fields has evolved, marred by sustained conflict, competition, mutual antipathy, and failed service inteyraunn efforts followed by resegregation of the fields. Pockets of successful behavioral health service integration at the local level within this history have been obscured by the overall bifurcation of behavioral health into separate addictions and mental health fields.

A recovery revolution now is occurring within and across the addictions and mental illness problem arenas that challenge practices within both of these fields, as well as their historical segregation. This paradigmatic shift will fuel debate over whether this recovery revolution is a long-awaited and desperately needed opportunity to revitalize, or a cataclysm that will deprotessionalize, and then destroy, both fields.

The purpose of this two-part scries is to explore whether the concept of recovery could serve as a conceptual bridge through which the treatments of addict ion and mental illness could be integrated within one recovery-oriented system of care. The authors speak as long-tenured Insiders within these fields, whose writings and presentations advocate embracing this revolution in thinking and practice.3-10

Service Integration: Inhibiting and Promoting Forces

A review ol the histories of the addictions and mental health fields provides three clues on why past service integration efforts migth have failed.

First, efforts to integrate have failed when they focused on discussions of the etiology or nature of these disorders or on treatment philosophies and techniques. Historically, common ground tor behavioral health integration does not lie in these arenas, although advances in neurobiology may yet establish such common ground.

Second, practitioners from both fields have been unprepared, and often unwilling, to treat clients from their sister field. The relationships between addiction treatment providers and clients with severe mental illness, and the relationships between mental health service providers and those with severe alcohol and other drug problems, have been characterized by institutionalized counter-transference (e.g., lack of empathy, disrespect, contempt, exclusion, and extrusion). Service integration ettorts often have tailed to address these attitudinal barriers.

Third, the historical conllict between these two fields is embedded in prolonged competition tor scarce resources, fears regarding the loss of institutional and professional legitimacy and integrity, and structural issues at the national level that drive segregated policies, funding streams, and regulatory oversight. Without a strongand shared conceptual foundation, the processes involved in service integration experiments have occurred largely by administration flat, and often were experienced at the front lines as one field attempting to colonize the resources of the other.

What is surprising in light of this history is theamtmued discussion regarding the potential advantages of an integrated behavioral health system. The forces pushing integration appear to be just as significant as those inhibiting it. People experiencing addictions and those with severe mental illness often have been considered hopeless and been the target of intense social stigma, manifested in their sequestration in almshouses, decaying asylums, jails, and prisons, or abandoned on the nation's streets. …

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