The value of recovery and recovery-oriented behavioral health systems is widely accepted by states, communities, healthcare providers, peers, families, researchers and advocates including the U.S. Surgeon General, the Institute of Medicine, and others. SAMHSA defines recovery from mental and/or substance use disorders as a process of change by which individuals pursue three primary goals to: 1) Improve their health – including behavioral health and wellness, 2) Live a self-directed life – to become more self-reliant and independent, and 3) Strive to reach their full potential –to fully contribute to American life.
Recovery is built on access to evidence-based clinical treatment and recovery support services for all populations. Recognizing this, SAMHSA has identified four major dimensions that support a life in recovery: 1) Health – access to affordable, accessible, and high quality health and behavioral healthcare, 2) Home – a safe, stable place to live, 3) Purpose – meaningful productive worthwhile activities such as a job, school, family care taking or other activities, and 4) Community – relationships and social support from families, peers, friends and others.
Here is one person’s story of the value of recovery and the four dimensions of health, home, purpose and community:
I grew up in a normal family, and I was a straight “A” student. But while I was in college, I began to hear voices telling me that I was nobody, that I was never going to make it in life. In 1977, I was hospitalized for schizophrenia. I was given electroconvulsive therapy, huge amounts of medication—the whole nine yards. I was in and out of the hospital and day treatment for a while, as the voices came and went. My mother was told that I would be disabled for the rest of my life, and she believed it—no one thought that a person with a mental illness like schizophrenia could recover.
My plan was to find a job, but I ended up homeless on the streets in Florida. I had no food, no medicine, and a job working a concession stand. For a while, I was living in someone’s garage, and in exchange for the living space, I had to do all kinds of work. When my symptoms became more severe, I was taken to a crisis unit.
This is where my story turns around. For the first time in my life, I was connected with a social worker who helped me get case management, Social Security, clothes, food, and shelter in an assisted living facility. My insecurities about living alone started to go away, and I felt motivated. This was the beginning of my recovery.
I was prescribed newer, more effective medicines, and that made the voices disappear for good. I was able to live on my own in a regular apartment for the first time. I learned basic coping skills from my case managers and friends, as well as from consumer advocates who had experience in the mental health system. Their help was so important in my recovery process; it made me want to give something back. I started telling my own story to consumers. Amazingly, I found that doing this not only inspired others, but helped my own recovery. The momentum kept building, like an upward spiral.
After 20 years, I finally went back to college. I got my bachelor’s and subsequent master’s degree in social work. At this point I was completely independent. I was off Social Security, off Medicare and Medicaid, off subsidized housing. I now own a condo through a rent-to-own program I created, and that’s where I live… with my wife. Did I forget to mention I got married?
Now, I’m the coordinator for a state consumer affairs office. I supervise peer specialists who are sharing their stories the way I shared mine. When my organization conducts focus groups with consumers, they usually say that it’s a little bit of everything that helped them the most. Not just medicine, not just therapy, not just financial stability, etc. It’s all important to work on, and it’s different for every consumer. Recovery is an individual thing. No one can tell you how to do it—the important thing is to know you can. You have the power and ability to make recovery a reality.
Within the health domain, clinical treatment plays a critical role in recovery. Access to safe and effective medications is a vital tool on the path to recovery for many people with mental and/or substance use disorders. We can think of recovery as a process by which people learn to manage their conditions and lead productive lives. It is facilitated by working with providers via medications, counseling, rehabilitative services, stress and relapse management, and other services and supports. Just as with other health conditions, medication is often a key part in achieving positive outcomes. However, medication is not effective for everyone or for every mental health condition, so there needs to be individualized approaches to care and treatment. The recovery model incorporates all of these variables and provides new hope to many individuals with serious mental illnesses.
To optimize the use of medications to assist recovery, consumers/peers, families, and providers need to be fully informed, engaged, and involved. SAMHSA has developed evidence-based approaches in areas such as shared decision-making, family psychoeducation, medication treatment, evaluation, and management, and provider training and clinical decision support.
Recovery brings hope. For too long, we, as a society, have assumed that people with mental and/or substance use disorders have a limited future and little to contribute. Recovery provides a common and motivating goal for consumers/peers, families, providers, and service systems that people can and do heal, overcome their illnesses, and live healthy, full and productive lives.