[acb-hsp] FW: Recovery to Practice Weekly Highlight Vol. 2, Issue No. 5 - February 11, 2011

[Baracco, Andrew W]

February 11, 2011                                                                                                                                        Volume 2, Issue 5


Please share the Recovery to Practice (RTP) Weekly Highlights with your colleagues, clients, friends, and family! If you are having trouble printing or viewing the RTP Weekly Highlight
in its entirety, please refer to the attached PDF. To access the RTP Weekly Highlights and other RTP materials, please visit http://www.dsgonline.com/rtp/resources.html.

 

What Does It Mean to Say That Recovery Is ‘Nonlinear’?

And What Implications Does This Have for Recovery-Oriented Practice?

by Larry Davidson, Ph.D., RTP Project Director

 

As more practitioners grapple with the implementation of recovery-oriented care, more people are beginning to ask about the “nonlinear” nature of recovery. What does it mean to say that recovery is nonlinear? The tenth of the 10 essential components of mental health recovery identified by the Substance Abuse and Mental Health Services Administration (SAMHSA) Consensus Development Conference in 2004, the issue of being nonlinear remains one of the least-understood aspects of recovery and one of the most difficult to apply in the development of recovery-oriented care. This Highlight will try to shed some light on this issue and begin to examine its implications for recovery-oriented care. 

 

Previous Highlights have discussed the fact that recovery has been defined both as an outcome and as a process. Because the implications of nonlinearity are different for each case, we will begin with the concept of recovery as outcome, that form of recovery that continues to be dominant in the culture of clinical settings and in the minds of most practitioners. Recovery as an outcome has also been described as “clinical recovery” (Slade, 2009) or recovering from a mental illness (Davidson and Roe, 2007). Its nonlinear nature is evident in the fact that most people do not recover from mental health conditions in a simple, straightforward, and uncomplicated manner that could be represented by a straight line tilting upward, as depicted in figure 1 below. This graph represents a linear path from an initial state of mental health, from which the person falls precipitously into a nadir of intense suffering, and then re-climbs the precipice back to a state of normalcy (however that is defined). 

 

Figure 1. A Linear Model of Recovery

 

	
	 	
 


Functioning



	
	 	
 


Age in Years

            

 

 

By describing recovery as nonlinear, we are emphasizing that reality seldom, if ever, resembles such a smooth ascent from the depths of psychosis or suffering to a state of well-being. Rather, we know the course of serious mental illnesses to involve both symptoms and functioning waxing and waning over time, with steps forward often accompanied by steps backward, and with periods of relative stability or progress alternating with periods of increased difficulty. The reality of the course and outcome of recovery is thus better depicted below in figure 2, with ups and downs of relative intensity and duration, leading overall perhaps to the positive outcome of being recovered, but as a result of a much more cyclical or circuitous route than a straight line would suggest. This is the kind of picture practitioners have in mind when they suggest that periods of increased difficulty—described by some as “relapses” or “recurrences”—are a part of recovery too. That is to say, these periods are experienced in addition to periods of growth or improvement.  

 

Figure 2. A Nonlinear Model of Recovery

 

	
	 	
 


Functioning



	
	 	
 


 Age in Years

 

            

 

And this is one important implication of the nonlinear nature of recovery: that people will often experience relapses, recurrences, or periods of increased difficulty, as well as periods of relative stability and growth, as they gradually, incrementally, and strenuously climb out of the hole into which mental illness has thrown them. Although important, this is not the only implication of the nonlinear nature of recovery for recovery-oriented practice, however. It also is important to recognize that, while such periods of increased difficulty may appear at times to emerge in response to life events (both positive and negative), people also report that there are times when the illness erupts or rears its ugly head with little or no warning and as if out of nowhere. As very little is actually known about what causes such exacerbations, both people in recovery and practitioners are left with a considerable deal of uncertainty about the future. 

 

Such uncertainty about the future may certainly be disquieting or uncomfortable, but it represents a huge step forward for the field, and for people in recovery and their loved ones, from the universal prognosis of lifelong disability and premature death that had traditionally been associated with serious mental illness. The fact is, at this stage of our knowledge and understanding of serious mental illnesses, we simply cannot predict the future and would be better off not trying to. What we can do is to appreciate the fear and trepidation people experience in their efforts to improve their lives—fears of relapses or recurrences and trepidation in taking any steps forward because of the instability this might cause. We can appreciate the Sisyphus-like courage and determination that are involved in people straining to push the boulder back up the hill once again after having been crushed by it, and after losing much in the process. And, most importantly, we can hold out hope for the person that his or her efforts will succeed in capturing more ground and achieving higher plateaus in his or her efforts to reclaim a meaningful and gratifying life out of the ravages of the illness.

 
A future Highlight will deal in more depth with appreciating the nonlinear nature of recovery of as a process—
what has also been described as “personal recovery” (Slade, 2009) or being in recovery (Davidson and Roe, 
2007). In relation to recovery as an outcome, practitioners will do well to hold out hope for improvements in the 
lives of all of the people they work with, no matter how serious or severe the disability may appear at any given 
time. Indeed, this possibility of sudden or unexpected improvements may be just as common as the sudden or 
unexpected setbacks previously described. This was acknowledged even by the founding fathers of 
psychopathology, Emil Kraepelin and Eugen Bleuler, who first defined serious mental illnesses as “chronic” 
conditions. Kraepelin, for example, noted that “improvements are not at all unusual, which in practice may be 
considered equivalent to cures” (1904, 28­–29), while Bleuler observed that this form of recovery can occur at 
any time, even after years of apparent disability and indifference. He wrote:    
There are patients who for many years are at the same stage of excitement but still give 
the impression, more or less, of being acute and are then again surprisingly capable of 
improvements; after 10 or 20 years in rarer cases, apparently entirely unsocial patients 
may be discharged as again capable of work. (1924, 440–41)
 

In this sense, we should learn from the nonlinear nature of recovery the lesson that we cannot possibly know when, under what circumstances, with what combination of resources, and in what ways a person with a serious mental illness may be able to regain an aspect of functioning, improve his or her life, or gain a foothold of control over the illness. Based on this understanding, we view our charge as enhancing the person’s access to such opportunities and offering him or her the supports and resources he or she might need in order to be successful in taking advantage of the opportunities offered. The only way to identify the opportunities, resources, and supports is through a trial-and-error fashion of exploring, in collaboration with the person, his or her interests and strengths, and encouraging and supporting the person in his or her efforts to gain a foothold or expand on a firm foundation of health in the process of reclaiming and rebuilding his or her life.

 

For further reading: 

Bleuler, E. (1924). Textbook of psychiatry (A.A. Brill, trans.). New York, N.Y.: The MacMillan Company.

Kraepelin, E. (1904). Lectures on clinical psychiatry (T. Johnstone, ed.). New York, N.Y.: William Wood and Company. 

Davidson, L., and Roe, D. (2007). Recovery from versus recovery in serious mental illness: One strategy for lessening confusion plaguing recovery. Journal of Mental Health, 16(4), 1–12.

Slade, M. (2009). Personal recovery and mental illness. Cambridge, England: Cambridge University Press.

 


*SAVE THE DATE*
Thursday, March 31, 2011

The RTP Resource Center is pleased to announce our first 2011 Webinar
and the second in a four-step series: 
Step 2 in the Recovery-Oriented Care Continuum: Person-Centered Care Planning

When
Thursday, March 31, 2011

Description
This Webinar will describe the approach of person-centered care planning as it is being developed for people with serious mental illnesses (and as informing the SAMSHA workbooks that are coming out of clearance). This includes identifying and setting goals, identifying and building on personal and familial strengths, identifying and addressing barriers and obstacles to recovery, and convening and assigning relevant tasks to members of the person’s “team,” including family and other natural supports. One speaker will describe the overall process and introduce participants to existing tools, a second speaker will address the role of culture and how person-centered care planning needs to at least be informed by culture but may also need to be adapted to a different cultural framework (e.g., familial-centered care for some Asian Americans), and a third speaker will describe his or her experience of participating in person-centered care planning as the focal person and contrast this to earlier experiences of traditional treatment planning.

More information on how to register will be forthcoming!

 

 

The RTP Resource Center Would Like to Share the Following Press Release
Regarding Investments in Prevention:

HHS Announces $750 Million Investment in Prevention

 

New health care law provides new funding to reduce tobacco use, obesity, and heart disease,
and build healthier communities

 

Department of Health and Human Services (HHS) Secretary Kathleen Sebelius today announced a $750 million investment in prevention and public health, funded through the Prevention and Public Health Fund created by the new health care law. Building on $500 million in investments last year, these new dollars will help prevent tobacco use, obesity, heart disease, stroke, and cancer; increase immunizations; and empower individuals and communities with tools and resources for local prevention and health initiatives.

 

"Prevention is something that can't just happen in a doctor's office. If we are to address the big health issues of our time, from physical inactivity to poor nutrition to tobacco use, it needs to happen in local communities," said Sebelius. "This investment is going to build on the prevention work already under way to help make sure that we are working effectively across the Federal government as well as with private groups and State and local governments to help Americans live longer, healthier lives."

 

The Prevention and Public Health Fund, part of the Affordable Care Act, is designed to expand and sustain the necessary capacity to prevent disease, detect it early, manage conditions before they become severe, and provide states and communities the resources they need to promote healthy living. In FY2010, $500 million of the Prevention Fund was distributed to States and communities to boost prevention and public health efforts, improve health, enhance health care quality, and foster the next generation of primary health professionals. Today, HHS posted new fact sheets detailing how that $500 million was allocated in every State. Those fact sheets are available at www.HealthCare.gov/news/factsheets/prevention02092011a.html <http://r20.rs6.net/tn.jsp?llr=sqa5umdab&et=1104463035923&s=13095&e=001rePfUJPYsfjl0_lsTQtv1KAdiycLpOBQh27CdXBTRb-z0SyI9OWX3HUlEMbyyWsb2kWWz65YwMGnrxGc9RFGSapKDvLKuBAqGmR_y7QIgvl0Hkon1q9CcA8ffDxtFXlbqeDveJvVRqvhpOCusX7WmkgoGVrKnzXQCH4Ya6nN6XvOvyvobLKoBg==> . 

 

This year, building on the initial investment, new funds are dedicated to expanding on four critical priorities:

*	Community Prevention ($298 million): These funds will be used to help promote health and wellness in local communities, including efforts to prevent and reduce tobacco use; improve nutrition and increase physical activity to prevent obesity; and coordinate and focus efforts to prevent chronic diseases like diabetes, heart disease, and cancer. 
*	Clinical Prevention ($182 million): These funds will help improve access to preventive care, including increasing awareness of the new prevention benefits provided under the new health care law. They will also help increase availability and use of immunizations, and help integrate behavioral health services into primary care settings. 

·    Public Health Infrastructure ($137 million): These funds will help State and local health departments meet 21st century challenges, including investments in information technology and training for the public health workforce to enable detection and response to infectious disease outbreaks and other health threats. 

·    Research and Tracking ($133 million): These funds will help collect data to monitor the impact of the Affordable Care Act on the health of Americans and identify and disseminate evidence-based recommendations on important public health challenges.

 

The Obama Administration recognizes the importance of a broad approach to addressing the health and well-being of our communities. Other initiatives put forth by the Obama Administration to promote prevention include

 

*	The President's Childhood Obesity Task Force and the First Lady's Let's Move! initiative aimed at combating childhood obesity 
*	The American Recovery and Reinvestment Act of 2009 that provides $1 billion for community-based initiatives, tobacco cessation activities, chronic disease reduction programs, and efforts to reduce health care–acquired infections 
*	The Affordable Care Act's National Prevention, Health Promotion and Public Health Council, composed of senior government officials, charged with designing a National Prevention and Health Promotion Strategy 

 

For more information about the FY2011 Prevention and Public Health Fund investments, visit www.HealthCare.gov/news/factsheets/prevention02092011b.html <http://r20.rs6.net/tn.jsp?llr=sqa5umdab&et=1104463035923&s=13095&e=001rePfUJPYsfh5xyLZEIwvDz7ywmLyxgOG52lO0qdcA4lJ3Cbu-2l8PYzPBKUTmQ_lS-WTGs5EHAHXvt4mc1OZH5OdPEKN66EFLIRlsagoex9ukSF2Ie7P_ebk4YK55ynYtYmBv-ZspHYYTPeB9o_shjHE0C7IxCQ4uClG5xZYV84EE_BaUGt2Og==> .

 

 

From Mental Health in the Headlines, Produced Weekly by Mental Health America:

Behavioral Health Spending Grew Less Than Overall Health Expenditures

Over a 20-year period from 1986 to 2005, mental health and substance use spending grew at a slower pace than spending on health care overall, according to a report by SAMHSA. Spending on mental health and substance use treatment also grew at a slower rate than gross domestic product in 2004 and 2005. “The recent recession, the full implementation of Federal parity law, and such health reform–related actions as the planned expansion of Medicaid all have the potential to improve access to mental health and substance abuse treatment and to alter spending patterns further,” said the authors of the report. The study, which appears in the journal, Health Affairs, found spending grew 4.8 percent for substance abuse, 6.9 percent annually for mental health, and 7.9 percent annually for all health care services during the 20-year period. (HealthDay News <http://www.businessweek.com/lifestyle/content/healthday/649565.html> , 2/04/11) 

 

To subscribe to Mental Health in the Headlines, visit http://www.mentalhealthamerica.net/go/action/subscribe.

 

For comments and suggestions, send an e-mail to Mental Health America at postmaster at mentalhealthamerica.net.

 

Mental Health America's Mental Health in the Headlines staff: Steve Vetzner, senior director, Media Relations.

 

 

SAMHSA ADS Center Training Teleconference:

Housing, Homelessness, and Social 

Inclusion: Essential Elements of Healthy Communities 

 

“Reconnecting to a viable sense of self and community is a crucial step in the recovery process for people who have experienced homelessness.”  —National Health Care for the Homeless

 

The National Alliance to End Homelessness estimates that, on any given night in the United States, an estimated 671,859 people experience homelessness. Homelessness has become a widespread public health issue. Stable housing is an essential human need and is a key social determinant of both health and mental health. Many who become homeless have a history of either childhood or adult trauma, or both, that can lead to the development of mental health problems and/or substance use disorders, which become worse when an individual lives on the streets or in shelters. 

 

SAMHSA’s Resource Center to Promote Acceptance, Dignity, and Social Inclusion Associated with Mental Health (ADS Center) invites you to a free training teleconference, titled, “Housing, Homelessness, and Social Inclusion: Essential Elements of Healthy Communities.” 

 

This teleconference will educate participants about current trends and practices in the field, recent precedent-setting court rulings to address violations of the Americans with Disabilities Act (ADA) and Olmstead, and the central role of social connectedness, social capital, and social inclusion as the foundation for developing programs that support people who have been homeless. Participants will also hear how one person moved from being homeless to being a homeowner and the lessons that can be learned from his recovery journey.

 

Date and Time

Wednesday, Feb. 23, 2011

3 p.m.–4:30 p.m. Eastern Time (ET)

 

Presenters

 

Livia Davis, MSW, CSWM  

Center for Social Innovation

SAMHSA Supportive Services  

Housing Technical Assistance Center

 

Bonnie Milstein, J.D. 

David L. Bazelon Center for Mental 

Health Law

 

Michael Kelly, CPS 

Housing for New Hope 

 

To Register 

Please visit the following page: http://promoteacceptance.samhsa.gov/teleconferences/default.aspx 

Please note: Registration will close at 5:00 p.m. ET on Sunday, Feb. 20, 2011. 

 

Questions?

This training teleconference will include a question-and-answer session. We invite you to submit questions at any time before or during the teleconference. To submit questions before the teleconference, please e-mail promoteacceptance at samhsa.hhs.gov. Speakers will answer as many questions as possible during the Q&A session, but we cannot guarantee that your question will be addressed. We will provide the presenters’ contact information so that you may contact them directly for a response or additional information. 

 

Please note: You may submit anonymous questions; however, if you provide your name and organization when submitting a question, we may use it during the call. 

 

Training Sponsor

This teleconference is sponsored by SAMHSA ADS Center, a project of the Center for Mental Health Services (CMHS). CMHS is a center within SAMHSA. Please explore the SAMHSA ADS Center Web site for more information: http://www.promoteacceptance.samhsa.gov <http://www.promoteacceptance.samhsa.gov/>  



 

 

The RTP Resource Center Wants to Hear From Recovery-Oriented Practitioners!

 

We invite practitioners to submit personal stories that describe how they became involved in recovery-oriented work and how it has changed the way they currently practice.

 

 The RTP Resource Center Wants to Hear From You, Too!

 

We invite you to submit personal stories that describe recovery experiences. To submit personal stories or other recovery resources, please contact Stephanie Bernstein, MSW, at 1.877.584.8535 or email 

recoverytopractice at dsgonline.com. 

 

 


We welcome your views, comments, suggestions, and inquiries.
For more information on this topic or any other recovery topics, 
please contact the RTP Resource Center at
1.877.584.8535 or email recoverytopractice at dsgonline.com.

The views, opinions, and content of this Weekly Highlight are those of the authors and do not necessarily reflect the views, opinions, or policies of SAMHSA or HHS.

 

 

 

 

 

 

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