Thursday, April 24, 2014
By JEANNINE D. LEPITRE
Greg Kesich got many things exactly right in his Feb. 13 editorial ("Newtown calls for different thinking on mental illness") including, "Recovery can be a lifelong struggle that requires not only professional care, but support from a community of family and friends."
Mental health professionals today know that recovery from mental illness is more possible than ever before, and that it takes a community to make it happen.
After Newtown, the public dialogue and policy debate is focused rightly on gun control and mental health services. To provide better mental health services, however, we need to re-examine -- and clearly define -- exactly where we're headed (strategy), how we get there (planning), and when we've arrived (outcomes).
We can start with the fact that mental illness is a brain disorder, so in one sense it's just as much a physical disease as cancer or diabetes. But because this disease is often expressed behaviorally, mental illness is freighted with a social stigma not generally associated with other physical diseases. This stigma isolates and tortures its sufferers, and in many cases keeps them from getting the treatment they need -- and is available -- to become fully functioning members of society.
And just like other physical diseases, mental illness is best treated in its earliest stages.
The concept of preventive care, however, needs clearer definition and greater emphasis.
Early, low-cost health care interventions almost always lessen, and sometimes eliminate, more costly ones down the road, both medically and financially.
But what, exactly, constitutes preventive care? One could argue a healthier diet, more exercise and regular medical check-ups.
But what about expensive lab tests, cancer screenings and CAT scans? Or, in the case of mental health, early childhood examinations, psychiatric evaluations and medication management?
The concept of recovery also needs clarification.
When applied to physical health, recovery is quite clear. You're sick or injured, and with medical intervention and sufficient time, you heal. The broken bone is mended, the cancerous lump is removed, the ruptured heart vessel is repaired. You have recovered from whatever ailed you.
With behavioral health (mental illness and substance abuse), the concept is trickier. Sufferers are never truly "healed" or "cured" as they are in the physical medical sense, so a plain and simple understanding of what we mean by recovery is even more important in this context.
The Substance Abuse and Mental Health Services, under the U.S. Department of Health and Human Services, has created a working definition of recovery for mental health and substance abuse disorders that, for many behavioral health professionals, works beautifully.
Recovery is defined by SAMHS as "a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential."
These 23 words provide a working definition of behavioral health recovery that, in SAMHSA's words "enable policy makers, providers, and others to better design, deliver, and measure integrated and holistic services to those in need."
The definition also comes with four major dimensions that support a life in recovery and 10 useful guiding principles.
The major dimensions are:
HEALTH: overcoming or managing one's diseases, as well as living in a physically and emotionally healthy way.
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.
COMMUNITY: relationships and social networks that provide support, friendship, love and hope.
SAMHSA's major guiding principles are: Recovery emerges from hope; recovery is person-driven; recovery is holistic; and recovery is based on respect.
Recovery is a process -- a healing path that leads to stability, empowerment, growth and happiness.
Because mental illness and substance abuse are chronic diseases, recovery is also a never-ending process. Over the past decade, science has greatly expanded our understanding and treatment of mental illness and addiction.
These advances have come from the hard science of labs and research, as well as the soft science of psychology and social work.
Thanks to new discoveries, insights, treatments and services, most mentally ill and addicted people in Maine can now live full, productive lives.
With clear definitions of concepts and goals, we can help guide them on their personal journeys of recovery.
And with recovery, we will decrease stigma, lessen violence and increase hope. Let the healing begin.
Jeannine D. Lepitre is chief executive officer of Counseling Services Inc.