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NASMHPD/NTAC e-Report on Recovery
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Implementing Recovery-based Care: Tangible Guidance for SMHAs

According to renowned researcher Courtenay Harding, Ph.D., recovery from mental illness has been researched and proven for decades, and she will cite ten studies from all over the globe as evidence (Harding, 2004). The irony is, as Harding will point out, you won’t find a section on recovery in the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders. In fact, you won’t even find the word in the manual’s index. Only a small minority of graduate mental health programs features a recovery focus, and on the administrative side, the topic of recovery is often overlooked, misunderstood, or moved to the back burner in the face of competing priorities.

Without any infrastructure for recovery-based mental health care, it’s no wonder that so many administrators and clinicians haven’t bought in to what is essentially a basic human right to feel better. In fact, just mentioning the word recovery seems to cause a stir depending on your training, beliefs, and role in the mental health rehabilitation system.

For the purposes of this e-Report, we will attempt to define ‘recovery’ so that the following articles have some context for all readers. We’ll begin by quoting Ruth Ralph, Ph.D., “Recovery can be defined as a process of learning to approach each day’s challenges, overcome our disabilities, learn skills, live independently and contribute to society. This process is supported by those who believe in us and give us hope” (2000).

Augmenting this definition, we cite a description from the President’s New Freedom Commission on Mental Health’s Achieving the Promise report, “The process in which people are able to live, work, learn, and participate fully in their communities. For some individuals, recovery is the ability to live a fulfilling and productive life despite a disability. For others, recovery implies the reduction or complete remission of symptoms” (2003).

Our addition to these descriptions would be that recovery is also supported by the power of consumer choice. All of these thoughts and ideas are represented in a conceptualization (pdf), produced by staff of the New York State Office of Mental Health, that attempts to illustrate the ups and downs of a recovery journey in a positive and illuminating light.

Thanks to the tireless work of recovery advocates and a boost from the rehabilitation language in Achieving the Promise, the concept of recovery from serious mental illness remains in the spotlight. However, this ongoing emphasis on an issue that some may feel is too intangible for action also presents practical challenges to state mental health authorities. What exactly is recovery-based care? How do you transform your system to reflect this concept? How do you measure your success?

We hope this NASMHPD/NTAC e-Report, with its preview of measurement tools now in development; its case studies of successful systems and ideas at federal, state and local levels; a discussion of workforce issues; and resources for more information, will help you implement the vision of Achieving the Promise to the betterment of your systems, administrators, providers, and especially the consumer/survivors whom we serve.

This report was produced by the National Association of State Mental Health Program Directors (NASMHPD) and the National Technical Assistance Center for State Mental Health Planning (NTAC) and is supported under a Contract between the Division of State and Community Systems Development, Center for Mental Health Services (CMHS), Substance Abuse and Mental Health Services Administration (SAMHSA), and the National Association of State Mental Health Program Directors. Its content is solely the responsibility of the author(s) and does not necessarily represent the position of SAMHSA or its centers.

Acknowledgements

NASMHPD/NTAC wish to thank the contributing authors to this report for their time, effort, and dedication. We would also like to thank Steven J. Onken, PhD, and Theodore Lutterman for their guidance on this topic.

References

Harding, C. (2004). Remission vs. recovery: Two very different concepts. Conference presentation at Reclaiming Lives: What Professionals Need to Know About Assessment, Planning, and Treatment for People Who Appear to be Stuck on the Road to Recovery, Boston University Center for Psychiatric Rehabilitation at the Sargent College of Health and Rehabilitation Sciences, April 13, 2004.

The President’s New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health care in America. Final report. DHHS Pub. No. SMA-03-3832. Rockville, MD: Department of Health and Human Services.

Ralph, R. (2000). Review of recovery literature: A synthesis of a sample of recovery literature 2000. Alexandria, VA: National Association of State Mental Health Program Directors (NASMHPD), National Technical Assistance Center for State Mental Health Planning (NTAC).

e-Report Table of Contents

Overcoming Obstacles to a Recovery-oriented System: The Necessity for State-level Leadership
By William A. Anthony, PhD

Federal Perspective: Recovery, Now!
By A. Kathryn Power, MEd, and Ronald W. Manderscheid, PhD

WRAP, Peer Support and Recovery: Tools for System Change
By Shery Mead, MSW, and Mary Ellen Copeland, MS, MA

Focus on the States: Implementing Recovery-based Care from East to West
By Robert Hennessy

Focus on the States: Getting Creative with Recovery Programs
Compiled from a report by Jennifer Brown

Tools In Development: Measuring Recovery at the Individual, Program, and System Levels
• At the Individual Level: A Personal Measure of Recovery
By Ruth O. Ralph, PhD
• At the Program Level: The Recovery Enhancing Environment Measure
By Priscilla Ridgway, MSW
• At the System Level: Self-Report Consumer Survey and Administrative-Data Profile
By Steven J. Onken, Ph.D.

Expert Panel Discusses Workforce Issues in the Face of a Recovery-Based Care Transformation
Featuring Patricia E. Deegan, PhD; Mary E. Jensen, RODC, MA, BSN; and Edward L. Knight, PhD, CPRP