A
Call For change:
Toward
A RECOVERY-ORIENTED
Mental
Health Service SYSTEM
for
Adults
A
Publication
Of
The
PENNSYLVANIA
Office
of Mental health
AND
Substance Abuse Services
ACKNOWLEDGEMENTS
Recovery Workgroup
Members
Kim Anglin,
Linda Bakmaz,
Shelley Bishop, Thomasina Bouknight, William
Boyer,
Mary Lyn Cadman, Michael
Chambers, Timothy
Connors, Michele Denk, Mary Jo Dickson,
Virginia Dikeman, Kate
Donegan, Suzanne Elhajj,
John Farmer, Cheryl
Floyd, Hickman Gardner, Jeff Geibel,
Scott Heller, Shirley
Hopper-Schaech, Jim Jordan, Diane Keefer, George
Kimes, Mary Kohut,
Glenn Koons, Gayle Lorenz,
Wendy Luckenbill,
Robert Manrodt, Jim
McCormack,
Edna McCutcheon, Karen Morton,
Nancy Porter, Robert Primrose,
Suzanne Ralph,
Mary Ellen Rehrman, Joseph Rogers, Jean Rush,
Mary Jeanne Serafin, Lewis Silverman, Betty Simmonds, Caroline
Smith, Kenneth Thompson,
Sue Walther, Carol
Ward-Colasante,
Rae Weber, Danny
Wildasin,
Wendy Wood, Dave Wooledge, Linda Zelch
Recovery Steering
Group Members
Linda Bakmaz,
Shelley Bishop, William Boyer,
Mary Lyn Cadman, Michelle
Denk, Cheryl Floyd, Jeff Geibel,
Scott Heller, Diane
Keefer, Mary Kohut, Jim
McCormack,
Betty Simmonds, Caroline Smith,
Kenneth Thompson, Linda
Zelch
Drexel University
College of Medicine/Behavioral Healthcare Education
Taylor Anderson,
Donna McNelis, Brenda
Weaver
Consultant
Laurie Curtis
A
Message from Joan
Erney
It
is with great optimism that I
present A Call for Change:
Toward a Recovery-Oriented Mental Health
Service System for Adults.
As I traveled
around the state recently participating in the Service Area Planning
meetings,
it became clear to me that we are in the midst of an exciting awakening
of
hope, realization, and change. The
meaningful stories, the emerging leadership, and the compelling impact
that a
strong consumer voice is having across this Commonwealth is already in
evidence. This
document is meant to
serve as a further tool to move us toward our statewide vision that
assures
that every person will have an opportunity for growth and recovery.
I
wish to thank the many
individuals who stimulated our thinking and committed to the hard work
of
developing this document, especially the work of the OMHSAS Advisory
Committee
Recovery Workgroup. A Call for Change clearly represents and
honors the voice of
individuals who are experiencing recovery and their undying advocacy to
establish the realization nationally and in Pennsylvania
that recovery from mental illness happens!
Recovery is the goal!
A
Call for Change establishes a firm foundation for the Pennsylvania
transformation to a recovery-oriented mental health system. It offers an understanding
of how we’ve
arrived at this time of recovery transformation, provides a concise
definition
of recovery, and further consideration of what a recovery-oriented
system is
and is not. Indicators
are provided to
serve as critical reference points for services, agencies and county
mental
health programs looking for more specific strategies for transforming
to more recovery-oriented
services. A Call for Change highlights the
challenges we have yet to address
and the need for us to engage in open, honest discussion and debate
about these
issues.
Most
importantly, we are called to
take the steps and risks associated with true transformation. As noted by William A.
Anthony, PhD.,
“Massive system changes must occur if the vision of recovery
is to become a
reality for an ever-increasing number of people with severe mental
illnesses. For this
very different vision to become
reality, brilliant leadership is required.”
A Call for Change
recognizes
and calls upon the brilliant leadership of all who are part of our
system –
consumers, family members, advocates, providers, policy-makers and
administrators – to effect true transformation in Pennsylvania.
OMHSAS
is dedicated to building on
the foundation of A Call for Change,
so that the opportunity of recovery is fully supported for all who are
served
in our public mental health system.
We
look forward to your dedication in working with us to achieve this goal.
Table
of Contents
ACKNOWLEDGEMENTS.. ii
A
Message from Joan Erney.. ii
Table
of Contents.. ii
Why
a Call for Change?. 2
Introduction.. 2
Envisioning a Transformed
System in Pennsylvania.. 2
Role of the OMHSAS
Advisory Committee and the Recovery Workgroup. 2
Scope and Role of A
Call For Change.. 2
The
Roots of Recovery in Mental Health.. 2
Deep Roots and a Legacy of
Reform... 2
Views of Recovery.. 2
Research &
Longitudinal Studies. 2
Civil Rights. 2
Pennsylvania
Consumer/Survivor/Expatient Movement.. 2
Community Support Programs
(CSP) 2
Addictions, 12-Steps, and
Mutual Support.. 2
Growing Recognition and
Interest in Mental Health Recovery.. 2
On the National Scene. 2
What
Does Recovery Look Like?. 2
More than Treatment or
Services. 2
Individual. 2
Programs/Services. 2
System... 2
Resiliency.. 2
But, We Already Do All
That! 2
Indicators
of a Recovery-Oriented Service System... 2
Recovery Is Not a New
“Model”. 2
Basic Domains. 2
Indicators of Recovery
Oriented Systems. 2
Implications
of Shifting Toward a Recovery-Oriented Mental Healthcare System... 2
Challenges and Barriers. 2
Addressing Challenges and
Barriers. 2
Toward
Transformation.. 2
Only a Beginning.. 2
Your Call to Change. 2
Conclusion.. 2
Why
a
Call for Change?
The
goal of a transformed system: Recovery
“Tangata
Whai Ora”: A term chosen by and used for people with
experience of mental
illness or distress in New
Zealand.
Translated it means “people seeking
wellness”.
˜™
Introduction
We have all seen them
– those pictures of people
confined to locked wards of rambling old hospitals, the hopeless look
in their
eyes, abandoned by family and friends, and facing a future that is
bleak and
desolate. It
doesn’t matter how old those
pictures are, the 1880’s, the 1940’s, the
1970’s, the eyes are still the
same. At different
times, there have
been waves of reform to improve conditions, to institute more effective
treatments, to seek new ways to promote and support healing from
psychiatric
disorders. We have
found new, more
helpful medications; we have helped people move from institutions to
settings
in our communities; we have found ways to help people find jobs or go
back to
school. We believe
we have had some
success in this work. And, to some degree we have. But too often, the
eyes are
still the same. People are still disconnected from family and friends,
isolated
within their communities, and often trapped in assumptions about bleak
futures
due to chronicity and disability.
During the past decade,
many voices have risen
to challenge some of the basic assumptions about mental illness and its
impact
on the lives of individuals and their families.
People with serious mental illnesses do, in fact, recover.
Some become
fully symptom-free with time, while others live rich and fulfilling
lives while
still experiencing some psychiatric problems.
The amalgamation of these voices has created what is now
known as the
“recovery movement” in mental health. One of the
basic premises of this
movement is that the role of a mental health service system is not to
“do for”
or to “do to”, but to “do with”
– recognizing a fundamental shift in roles,
power, and responsibility for providers and consumers alike. It is not about units of
care, placement, or
“functioning” or even a cure per se; it is about
building real lives. It is
both a goal or destination and a continual, very human process of
growth,
change, and healing.
The recovery movement is
impacting the mental
health system at all levels by challenging mental health providers,
administrators, policy-makers, funders, workers, as well as people who
experience mental health problems and their families to look at how
negative or
limiting assumptions are driving approaches to services, to funding, to
treatment, to policies, and ultimately to the course of
individual lives. The
federal government has issued a call for
sweeping transformation of the mental health service system throughout
the United States.
In Pennsylvania,
this document, A Call for Change: Toward
a Recovery-Oriented Mental Health Service System, carries
this same mandate
for change into the Commonwealth, building upon our current efforts,
and
providing a foundation for further reflection, discussion, planning and
ultimately our transformation to a more recovery-oriented mental health
service
system for adults in this State.
Drawing from the
experiences and ideas of
Pennsylvanians, as well as contemporary literature and the experience
of other
states in tackling these changes, A Call for
Change presents what is currently known about the elements of
a
recovery-oriented mental health system and presents a set of indicators
by
which the process and outcomes of transformation may be evaluated.
OMSHAS
expects that this document will help to articulate a more detailed
vision of
what a recovery-oriented system will look like in Pennsylvania
at the state and local levels, and introduces the Call
to Action for more strategically defining the necessary steps
of transformation.
In November, 2004 the
Pennsylvania Recovery
Workgroup generated this definition of recovery to guide service system
transformation in this State. It
was
fully endorsed by the Pennsylvania Office of Mental Health Substance
Abuse
Services (OMHSAS) in 2005.
Recovery
is a self-determined and holistic journey that
people undertake to heal and grow.
Recovery is facilitated by relationships and environments
that provide
hope, empowerment, choices and opportunities that promote people
reaching their
full potential as individuals and community members.
Operationalizing this
definition of recovery
throughout the Pennsylvania
public mental health service system for adults is the prime goal and
vision of
this document.
Envisioning
a Transformed System
in Pennsylvania
OMHSAS Vision & Guiding Principles
In 1995 Deputy Secretary
Charles Curie
developed the first OMHSAS mission statement that included an
expectation that
every person served within the system will have the opportunity for
recovery. In 2003
under the leadership
of Deputy Secretary Joan Erney,
the OMHSAS,
with input from representatives of all major stakeholder groups,
developed a
recovery-focused vision statement of a transformed service system in Pennsylvania.
To support this vision,
OMHSAS also identified a
core set of guiding principles that outline primary tenets to be
reflected in
all change initiatives. These
guiding
principles are as follows.
Guiding Principles
The Mental Health and Substance
Abuse Service System will
provide quality services and supports that:
· Facilitate
recovery for adults and resiliency
for children;
· Are
responsive to individuals’ unique strengths
and needs throughout their lives;
· Focus
on prevention and early intervention;
· Recognize,
respect and accommodate differences
as they relate to culture/ ethnicity/race, religion, gender identity
and sexual
orientation;
· Ensure
individual human rights and eliminate
discrimination and stigma;
· Are
provided in a comprehensive array by
unifying programs and funding that build on natural and community
supports
unique to each individual and family;
· Are
developed, monitored and evaluated in
partnership with consumers, families and advocates;
· Represent
collaboration with other agencies and
service systems.
Role
of the OMHSAS Advisory
Committee and the Recovery Workgroup
In May 2004, OMHSAS
redesigned its Advisory
Committee Structure to be more inclusive and more responsive to the
various
stakeholder groups. This re-organized structure took on the
responsibilities of
the previous Mental Health Planning Council, and further identified its
role to
provi