SAMHSA "Recovery Model" Drives Services Away From the Most Seriously Mentally Ill - Mental Illness Policy Org
SAMHSA “Recovery Model” Drives Services Away From the Most Seriously Mentally Ill 2017-02-02T08:28:30+00:00

SAMHSA created their own definition of “RECOVERY” that drove services away from people with serious mental illness

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  • The dictionary defines recovery in 15 words as a return to health: the return to normal health of somebody who has been ill or injured.”
  • Under that definition, most people with serious mental illness do not recover. They remain symptomatic even with treatment.
  • SAMHSA wanted to support a politically correct idea that everyone recovers. To do that, they created their own 1100+ word defintion of recovery.

SAMHSA Process to Define Recovery was expensive, time-consuming and wasteful

  • In August 2010 SAMHSA kicked off their search for a definition of “recovery” with a “Dialogue Meeting”
  • It was followed by an extensive formal “public engagement process” that ended one year later.
  • Internal reviews went on another four months
  • In December 2011 SAMHSA issued a definition of recovery and guiding principles.
  • SAMHSA decided to revise the definition.
  • March 2012, 18 months after they started. SAMHSA issued their 1,113 word new definition of ‘recovery’ and principles to achieve it. (Below).

SAMHSA came up with a meaningless definition of ‘recovery’:

  • Recovery is “A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.”
  • As a result of this definition, everyone recovers. Recovery no longer has anything to do with symptom elimination or return to health. It is a “process”.
  • They also developed the “principles” to achieve Recovery

Problems with SAMHSA definition of ‘recovery’:

  • Prior to SAMHSA requiring states use the “Recovery Model”, states used a “Medical Model” that delivered symptom amelioration supports (like medication) to the seriously ill. The Recovery Model forced states to instead fund a “process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential” Improving everyone’s mental health was in, treating serious mental illness out.
  • By redefining recovery SAMHSA reinforced the myth that everyone recovers, mainly because recovery has lost all meaning.
  • By including “improving health and wellness” in the definition, they encouraged states to divert funds from alleviating symptoms of serious mental illness.
  • By including “live a self-directed life” they insured SAMHSA funds would not reach some of the most seriously ill, who are too psychotic to lead a self-directed life and may need involuntary interventions.
  • The “Principles of Recovery” are to support “physical and emotional wellbeing.” (versus mental illness);

Significance of SAMHSA using own defintion of ‘recovery’ rather than dictionary definition

  • SAMHSA coerces states to use the $2 billion in Mental Health Block Grants (MHBG) distributed by SAMHSA on this ‘Recovery’ model.
  • States have been encouraged by groups provided funding by SAMHSA and public interest law firms funded by SAMHSA to adopt the Recovery Model.
  • California’s Mental Health Services Act has raised over $8 billion for services to help “people with severe mental illness”. But the Oversight Commission adopted SAMHSA’s “Recovery Model” and so much of the $8 billion is not being spent on people without serious mental illness, that state auditor has started an investigation.
  • Programs that have historically helped people with mental illness (like Clubhouses) are being closed.

Responsibility for the SAMHSA Recovery fiasco rests with Administrator Pamela Hyde and CMS Director del Vecchio.

  • This is not some bureaucrat run amok. The process was driven by SAMHSA Director Pamela Hyde and CMHS Acting Director Paolo del Vecchio. (Who also used same process to define “trauma” “resiliency”, etc.)
  • They wrote they needed the definition to drive funding (“to promote the…financing of vital services and supports that facilitate recovery for individuals.”)
  • Mr. del Vecchio wrote the definition is consistent with SAMHSA’s mission “to promote a high-quality and satisfying life in the community for all Americans.” That is a gross misrepresentation of SAMHSA’s mission which is to help the seriously mentally ill, not “all Americans”

 

COMPLETE SAMHSA DEFINITION OF RECOVERY

 

Recovery from Mental Disorders and/or Substance Use Disorders:  A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.
Through the Recovery Support Strategic Initiative, SAMHSA has delineated four major dimensions that support a life in recovery:

  • Health:  overcoming or managing one’s disease(s) or symptoms—for example, abstaining from use of alcohol, illicit drugs, and non-prescribed medications if one has an addiction problem—and for everyone in recovery, making informed, healthy choices that support physical and emotional wellbeing.
  • Home:  a stable and safe place to live;
  • Purpose:  meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society; and
  • Community:  relationships and social networks that provide support, friendship, love, and hope.

 Guiding Principles of Recovery
 Recovery emerges from hope:  The belief that recovery is real provides the essential and motivating message of a better future – that people can and do overcome the internal and external challenges, barriers, and obstacles that confront them.  Hope is internalized and can be fostered by peers, families, providers, allies, and others.  Hope is the catalyst of the recovery process.
Recovery is person-driven:  Self-determination and self-direction are the foundations for recovery as individuals define their own life goals and design their unique path(s) towards those goals.  Individuals optimize their autonomy and independence to the greatest extent possible by leading, controlling, and exercising choice over the services and supports that assist their recovery and resilience. In so doing, they are empowered and provided the resources to make informed decisions, initiate recovery, build on their strengths, and gain or regain control over their lives.
Recovery occurs via many pathways:  Individuals are unique with distinct needs, strengths, preferences, goals, culture, and backgrounds ? including trauma experiences ? that affect and determine their pathway(s) to recovery. Recovery is built on the multiple capacities, strengths, talents, coping abilities, resources, and inherent value of each individual.  Recovery pathways are highly personalized.  They may include professional clinical treatment; use of medications; support from families and in schools; faith-based approaches; peer support; and other approaches.  Recovery is non-linear, characterized by continual growth and improved functioning that may involve setbacks.  Because setbacks are a natural, though not inevitable, part of the recovery process, it is essential to foster resilience for all individuals and families. Abstinence from the use of alcohol, illicit drugs, and non-prescribed medications is the goal for those with addictions.  Use of tobacco and non-prescribed or illicit drugs is not safe for anyone. In some cases, recovery pathways can be enabled by creating a supportive environment. This is especially true for children, who may not have the legal or developmental capacity to set their own course.
Recovery is holistic:  Recovery encompasses an individual’s whole life, including mind, body, spirit, and community.  This includes addressing: self-care practices, family, housing, employment, education, clinical treatment for mental disorders and substance use disorders, services and supports, primary healthcare, dental care, complementary and alternative services, faith, spirituality, creativity, social networks, transportation, and community participation.  The array of services and supports available should be integrated and coordinated.
Recovery is supported by peers and allies:  Mutual support and mutual aid groups, including the sharing of experiential knowledge and skills, as well as social learning, play an invaluable role in recovery.  Peers encourage and engage other peers and provide each other with a vital sense of belonging, supportive relationships, valued roles, and community.  Through helping others and giving back to the community, one helps one’s self.  Peer-operated supports and services provide important resources to assist people along their journeys of recovery and wellness.  Professionals can also play an important role in the recovery process by providing clinical treatment and other services that support individuals in their chosen recovery paths.  While peers and allies play an important role for many in recovery, their role for children and youth may be slightly different.  Peer supports for families are very important for children with behavioral health problems and can also play a supportive role for youth in recovery.
Recovery is supported through relationship and social networks:  An important factor in the recovery process is the presence and involvement of people who believe in the person’s ability to recover; who offer hope, support, and encouragement; and who also suggest strategies and resources for change.  Family members, peers, providers, faith groups, community members, and other allies form vital support networks. Through these relationships, people leave unhealthy and/or unfulfilling life roles behind and engage in new roles (e.g., partner, caregiver, friend, student, employee) that lead to a greater sense of belonging, personhood, empowerment, autonomy, social inclusion, and community participation.
Recovery is culturally-based and influenced: Culture and cultural background in all of its diverse representations ? including values, traditions, and beliefs ? are keys in determining a person’s journey and unique pathway to recovery.  Services should be culturally grounded, attuned, sensitive, congruent, and competent, as well as personalized to meet each individual’s unique needs.
Recovery is supported by addressing trauma:  The experience of trauma (such as physical or sexual abuse, domestic violence, war, disaster, and others) is often a precursor to or associated with alcohol and drug use, mental health problems, and related issues.  Services and supports should be trauma-informed to foster safety (physical and emotional) and trust, as well as promote choice, empowerment, and collaboration.
Recovery involves individual, family, and community strengths and responsibility:  Individuals, families, and communities have strengths and resources that serve as a foundation for recovery.  In addition, individuals have a personal responsibility for their own self-care and journeys of recovery.  Individuals should be supported in speaking for themselves. Families and significant others have responsibilities to support their loved ones, especially for children and youth in recovery.  Communities have responsibilities to provide opportunities and resources to address discrimination and to foster social inclusion and recovery.  Individuals in recovery also have a social responsibility and should have the ability to join with peers to speak collectively about their strengths, needs, wants, desires, and aspirations.
Recovery is based on respect:  Community, systems, and societal acceptance and appreciation for people affected by mental health and substance use problems – including protecting their rights and eliminating discrimination – are crucial in achieving recovery.  There is a need to acknowledge that taking steps towards recovery may require great courage. Self-acceptance, developing a positive and meaningful sense of identity, and regaining belief in one’s self are particularly important.
SAMHSA has developed this working definition of recovery to help policy makers, providers, funders, peers/consumers, and others design, measure, and reimburse for integrated and holistic services and supports to more effectively meet the individualized needs of those served.
Many advances have been made to promote recovery concepts and practices.  There are a variety of effective models and practices that States, communities, providers, and others can use to promote recovery.  However, much work remains to ensure that recovery-oriented behavioral health services and systems are adopted and implemented in every state and community.  Drawing on research, practice, and personal experience of recovering individuals, within the context of health reform, SAMHSA will lead efforts to advance the understanding of recovery and ensure that vital recovery supports and services are available and accessible to all who need and want them