A Model of Being in Recovery as a Foundation for Recovery-Oriented Practice

2008 ◽  
Author(s):  
Larry Davidson ◽  
Michael Rowe ◽  
Janis Tondora ◽  
Maria J. O'Connell ◽  
Martha Staeheli Lawless
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Serious Mental Illness ◽  
The Other ◽  
Service Development ◽  
Recovery Plan ◽  
Individual Level ◽  
Services And Supports ◽  
The Individual

We begin this second chapter where we left off in the preceding one, with the question of what is involved in the work of recovery and how practitioners can best support this work. On one hand, we understand the answer to this question to be very much a work in progress. There is much still to learn about recovery and recovery-oriented care, and we consider the field—including our own efforts in this regard—to be in the very early stages of its development. On the other hand, we have begun to learn some things about what processes of recovery entail and what the provision of recovery-oriented care looks like in practice, as well as about some of the structural conditions necessary for this kind of care to be implemented. In this chapter, we share some of these lessons by describing components and processes of being in recovery that we have integrated into a model that can then serve as the foundation for developing recovery-oriented practices. The assumption of this approach, as we mentioned in the previous chapter, is that this form of recovery is primarily the responsibility of the person with a serious mental illness. What practitioners do should thus be oriented to supporting and facilitating the person’s own efforts. We describe this perspective as a “bottom up” approach to service development, as it begins with the needs, preferences, and goals of the person in recovery— not only at the individual level of a person’s “recovery plan” but also at the collective level of the system as a whole. What services and supports should a mental health system offer? Those, we suggest, that will enable persons with serious mental illness to lead safe, dignified, and gratifying lives beyond the illness—when possible— or, when that is not possible, within the boundaries imposed by the illness. Before turning to the question of what services and supports we need to offer to promote and sustain recovery, we need to understand better what being in recovery entails. To frame the question in this way is not to ignore the other form of recovery (i.e., recovery from mental illness).

Accomplishing Team: Teamwork and Categorisation in Two Community Mental Health Teams

1997 ◽  
Vol 45 (1) ◽  
pp. 59-78 ◽  
Author(s):  
Lesley Griffiths
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Community Mental Health ◽  
Serious Mental Illness ◽  
Target Population ◽  
The Other ◽  
Team Meetings ◽  
The Social ◽  
Inclusive Approach ◽  
Definition Of

This paper describes the social organisation of two newly-formed community mental health teams, examining their differing relationship with team psychiatrists and the resulting constitution of team activities. Different ways of accomplishing ‘team’ had consequences for the ways mental illness was categorised and the target population for services was framed. The attendance or non-attendance of psychiatrists at team meetings, and the framing of meetings as ‘allocation’ or ‘review’, critically affected the nature of teamwork. One team took advantage of the absence of the psychiatrist to resist the bureaucratic framing of its task as ‘allocation’, and gained some autonomy by delaying acceptance of ‘inappropriate’ patients onto caseloads. The second team met regularly with its psychiatrist and was allowed a voice in the ‘review’ of cases, but discussions and decisions fell largely under the control of the dominant professional. Transcripts of team meetings are analyzed to show how the two teams develop divergent discursive repertoires, which are then deployed in the categorisation of patients. The team who meet without the psychiatrist attempt to control their workload by developing a relatively exclusionary definition of serious mental illness which excludes the ‘worried well’, while the other team take a more inclusive approach.

The Role of the Recovery Guide

2008 ◽  
Author(s):  
Larry Davidson ◽  
Michael Rowe ◽  
Janis Tondora ◽  
Maria J. O'Connell ◽  
Martha Staeheli Lawless
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Case Management ◽  
Serious Mental Illness ◽  
Service Use ◽  
Systems Of Care ◽  
Mental Health Systems ◽  
State Hospitals ◽  
Provision Of Services ◽  
Services And Supports

We have defined and discussed the nature of various notions of recovery, grappled with the implications of a recovery vision for mental health system transformation, and begun to draw the outlines of a transformed system. Now we can turn to the question of how such services and supports can actually be offered to people who need them. Here we propose what we call the recovery guide model. Analogous to the role currently played by case management, the recovery guide model is an organizing vehicle by which practitioners can offer a range of services and supports to people, either directly or through others. As with case management, the intensity, scope, focus, and duration of a recovery guide’s work with a person will depend on that person’s needs, preferences, life circumstances, and goals at a given point in his or her unique recovery journey. In this chapter we describe the basic aims, tenets, and tools of this approach. First, though, we offer a brief review of advances in mental health case management that preceded and led up to the concept of recovery guides, including the present recognition that, in a recovery-oriented system of care, people with serious mental illness can no longer be considered “cases” that others manage (Everett & Nelson, 1992). With the failure of a combination of Thorazine and psychotherapy to achieve the aims of deinstitutionalization (Johnson, 1992), case management became the predominant service that mental health systems offered their clients with serious mental illness (Sledge, Astrachan, Thompson, Rakfeldt, & Leaf, 1995). In addition to being inadequately funded, community-based systems of care that were developed to enable people with serious mental illness to leave state hospitals were fragmented and uncoordinated “non-systems” of care (Hoge, Davidson, Griffith, & Jacobs, 1998). As it was practically impossible for people seeking care to navigate these complex and unintegrated health and social service systems on their own, the case manager role was created to identify and coordinate the provision of services to meet their multiple needs in the community (Hoge, Davidson, Griffith, Sledge, & Howenstine, 1994; Sledge et al., 1995). Case managers’ primary responsibility was to assess people’s needs, link them to services, and monitor their service use and outcomes.

The Evolution of the Role of U.S. School Nurses in Adolescent Mental Health at the Individual, Community, and Systems Level: An Integrative Review

2022 ◽  
pp. 105984052110681
Author(s):  
Ashwini R. Hoskote ◽  
Emily Croce ◽  
Karen E. Johnson
Keyword(s):  
Mental Health ◽  
Adolescent Mental Health ◽  
School Nurse ◽  
School Nurses ◽  
Integrative Review ◽  
School Nursing ◽  
Individual Level ◽  
The Individual ◽  
The Impact

School nurses are crucial to addressing adolescent mental health, yet evidence concerning their evolving role has not been synthesized to understand interventions across levels of practice (i.e., individual, community, systems). We conducted an integrative review of school nurse roles in mental health in the U.S. related to depressive symptoms, anxiety, and stress. Only 18 articles were identified, published from 1970 to 2019, and primarily described school nurses practicing interventions at the individual level, yet it was unclear whether they were always evidence-based. Although mental health concerns have increased over the years, the dearth of rigorous studies made it difficult to determine the impact of school nurse interventions on student mental health outcomes and school nurses continue to feel unprepared and under supported in this area. More research is needed to establish best practices and systems to support school nursing practice in addressing mental health at all levels of practice.

scholarly journals Therapeutic Social Control of People with Serious Mental Illness: An Empirical Verification and Extension of Theory

2017 ◽  
Vol 8 (2) ◽  
pp. 108-122 ◽  
Author(s):  
Brea L. Perry ◽  
Emma Frieh ◽  
Eric R. Wright
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Social Control ◽  
Serious Mental Illness ◽  
Mental Health Treatment ◽  
Structured Interview ◽  
Ethical Challenges ◽  
Therapeutic Goals ◽  
Contraception Use ◽  
Client Behavior

Mental health services and psychiatric professional values have shifted in the past several decades toward a model of client autonomy and informed consent, at least in principle. However, it is unclear how much has changed in practice, particularly in cases where client behavior poses ethical challenges for clinicians. Drawing on the case of clients’ sexual behavior and contraception use, we examine whether sociological theories of “soft” coercion remain relevant (e.g., therapeutic social control; Horwitz 1982) in contemporary mental health treatment settings. Using structured interview data from 98 men and women with serious mental illness (SMI), we explore client experiences of choice, coercion, and the spaces that lie in between. Patterns in our data confirm Horwitz’s (1982) theory of therapeutic social control but also suggest directions for updating and extending it. Specifically, we identify four strategies used to influence client behavior: coercion, enabling, education, and conciliation. We find that most clients’ experiences reflect elements of ambiguous or limited autonomy, wherein compliance is achieved by invoking therapeutic goals. However, women with SMI disproportionately report experiencing intense persuasion and direct use or threat of force. We argue that it is critical to consider how ostensibly noncoercive and value-free interventions nonetheless reflect the goals and norms of dominant groups.

scholarly journals Creating a ‘reverse’ integrated primary and mental healthcare clinic for those with serious mental illness

2015 ◽  
Vol 17 (05) ◽  
pp. 421-427 ◽  
Author(s):  
Alexandros Maragakis ◽  
Ragavan Siddharthan ◽  
Jill RachBeisel ◽  
Cassandra Snipes
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Illness ◽  
Quality Of Care ◽  
Serious Mental Illness ◽  
Mental Healthcare ◽  
Policy Reforms ◽  
Mental Health Settings ◽  
Primary Care Practitioners

Individuals with serious mental illness (SMI) are more likely to experience preventable medical health issues, such as diabetes, hyperlipidemia, obesity, and cardiovascular disease, than the general population. To further compound this issue, these individuals are less likely to seek preventative medical care. These factors result in higher usage of expensive emergency care, lower quality of care, and lower life expectancy. This manuscript presents literature that examines the health disparities this population experiences, and barriers to accessing primary care. Through the identification of these barriers, we recommend that the field of family medicine work in collaboration with the field of mental health to implement ‘reverse’ integrated care (RIC) systems, and provide primary care services in the mental health settings. By embedding primary care practitioners in mental health settings, where individuals with SMI are more likely to present for treatment, this population may receive treatment for somatic care by experts. This not only would improve the quality of care received by patients, but would also remove the burden of managing complex somatic care from providers trained in mental health. The rationale for this RIC system, as well as training and policy reforms, are discussed.

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