National Consensus Statement on Mental Health Recovery in the USA

Professor Kam-shing YIP

Department of Applied Social Sciences

The Hong Kong Polytechnic University

National Consensus Statement on Mental Health Recovery

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESSubstance Abuse and Mental Health Services AdministrationCenter for Mental Health Serviceswww.samhsa.gov

Background

Recovery is cited, within Transforming Mental Health Care in America, Federal Action Agenda: First Steps, as the "single most important goal" for the mental health service delivery system.

To clearly define recovery, the Substance Abuse and Mental Health Services Administration within the U.S. Department of Health and Human Services and the Interagency Committee on Disability Research in partnership with six other Federal agencies convened the National Consensus Conference on Mental Health Recovery and Mental Health Systems Transformation on December 16-17, 2004.

Over 110 expert panelists participated, including mental health consumers, family members, providers, advocates, researchers, academicians, managed care representatives, accreditation organization representatives, State and local public officials, and others.

Background

A series of technical papers and reports were commissioned that examined topics such as:

- recovery across the lifespan, - definitions of recovery, - recovery in cultural contexts, - the intersection of mental health and

addictions recovery, - and the application of recovery at individual,

family, community, provider, organizational, and systems levels.

Definition of Recovery

The following consensus statement was derived from expert panelist deliberations on the findings.

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.

The 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.

The 10 Fundamental Components of Recovery

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.

The 10 Fundamental Components of Recovery

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.

The 10 Fundamental Components of Recovery

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, 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

The 10 Fundamental Components of Recovery

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.

The 10 Fundamental Components 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). Th e process of recovery moves forward through interaction with others in supportive, trust-based relationships.

The 10 Fundamental Components of Recovery

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.

The 10 Fundamental Components of Recovery

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.

The 10 Fundamental Components of Recovery

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. Mental health recovery not only benefi ts individuals with mental health disabilities by focusing on their abilities to live, work, learn, and fully participate in our society, but also enriches the texture of American community life. America reaps the benefi ts of the contributions individuals with mental disabilities can make, ultimately becoming a stronger and healthier Nation.

Response of National Coalition of Mental HealthConsumer/Survivor Organizations

The Coalition supports the efforts of the federal Substance Abuse and Mental Health Services Administration (SAMHSA) to transform the mental health system to one that is recovery-based and consumer- and family-driven, and supports SAMHSA’s consensus statement on recovery (www.mentalhealth.samhsa.gov/publications/allpubs/sma05-4129/). The Coalition proposes a new consensus for the mental health field based on the following principles:

Recovery is possible for everyone. To recover, we need services and supports that treat us with dignity, respect our rights, allow us to make choices, and provide assistance with our self-defined needs. This range of services must include consumer-run and -operated programs.

Self Determination: We need to be in control of our own lives.

Holistic Choices: We need choices, including a range of recovery-oriented services and supports that provide assistance with housing, education, and career development.

Voice: We must be centrally involved in any dialogues and decisions affecting us.

Personhood: We will campaign to eliminate the stigma and discrimination associated with mental illnesses.

NASW Practice Snapshot: The Mental Health Recovery Model

Office of Social Work Specialty Practice The mental health Recovery Model is a treatment concept wherein a

service environment is designed such that consumers have primary control over decisions about their own care.  This is in contrast to most traditional models of service delivery, in which consumers are instructed what to do, or simply have things done for them with minimal, if any, consultation for their opinions.  The Recovery Model is based on the concepts of strengths and empowerment, saying that if individuals with mental illnesses have greater control and choice in their treatment, they will be able to take increased control and initiative in their lives.

The Recovery “movement” refers to a mostly grassroots initiative that also encourages these tenets, and has as a goal the recovery from mental illness.  Helping achieve these goals is consistent with the values of the social work profession, which is committed to the empowerment and self-determination for all populations, particularly those who are traditionally disenfranchised.  This Snapshot discusses some of the ways in which the tenets of the Recovery Model may affect clinical practice in facilities that support individuals with mental illnesses.  Some short recommendations are also made for how to orient one’s own work to reflect the recovery ideas. 

NMHA Position StatementIn Support of Recovery-Based Systems

Transformation

NMHA supports and promotes mental health services and systems that facilitate recovery among individuals with mental illness. NMHA believes mental health systems transformation will occur only when all stakeholders view recovery as the primary goal.

NMHA Position StatementIn Support of Recovery-Based Systems

Transformation NMHA is committed to the principle that every individual with a

mental illness can recover. Individuals must define for themselves what recovery means to

them For some it may mean achieving personal goals to live a

fulfilling and productive life and for others it may mean effectively managing the effects of their illness.

For an individual to engage in the recovery process, it is important that she or he possess hope that recovery is possible, have choices regarding culturally and linguistically competent community-based services and supports, have access to resources that allow for basic needs to be met such as food, clothing and housing and have a strong community network.

Such a network can include but is not limited to friends, family and faith-based organizations.

NMHA Position StatementIn Support of Recovery-Based Systems

Transformation Call to Action

NMHA supports consumers to: Understand their illness and that recovery is

possible; Explore culturally and linguistically competent

treatment options and supports that match their desires, goals and strengths; and

Participate in peer support programs and explore leadership roles that can help others recover.

NMHA Position StatementIn Support of Recovery-Based Systems

Transformation NMHA calls on public mental health systems and policy-

makers to: Incorporate the principles of recovery-based care

into the mission and day-to-day activities of local, state and federal mental health departments and agencies;

Invest in evidence-based and emerging practices that are community-based and consumer/family-driven; and

Ensure that consumers have meaningful involvement in the planning, delivery and evaluation of mental

health service systems.

NMHA Position StatementIn Support of Recovery-Based Systems

Transformation NMHA encourages mental health advocates to: Educate decision makers that recovery is possible

and is the expected outcome of proper treatment and supports;

Correct misinformation reported in the media with positive, factual, and prompt responses expressed with the dignity we demand for those who suffer from a mental illness;

Promote policies which are consistent with the recovery philosophy; and

Identify opportunities for consumers to have meaningful involvement in advocacy efforts in addition to the planning, delivery and evaluation of mental health services.

NMHA Position StatementIn Support of Recovery-Based Systems

Transformation

NMHA urges the media to: Learn the facts about mental illness; Report upon and portray mental illnesses

with appropriate sensitivity; and Recognize that stigmatizing language and

attitudes prevent effective treatment of mental illnesses.