The Role of the Recovery Guide

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.