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NASMHPD/NTAC e-Report on Recovery – Fall 2004

Overcoming Obstacles to a Recovery-oriented System: The Necessity for State-level Leadership

By William A. Anthony, Ph.D.

Dr. Anthony is the executive director of the Boston University Center for Psychiatric Rehabilitation. He is also the principal investigator for the Research Infrastructure Support Program, and a professor of Rehabilitation Counseling at the Sargent College of Health and Rehabilitation Sciences, Boston University.

I was asked by NASMHPD/NTAC to comment on overcoming the system’s barriers to recovery. In other venues my colleagues and I at the Center for Psychiatric Rehabilitation have mentioned the lack of research on recovery outcomes (Anthony, 2001), suggested strategies for improving such research (Anthony, Rogers & Farkas, 2003), identified the components of a recovery oriented system (Anthony, 2000), and described the values underlying recovery programming (Farkas, Gagne, Anthony & Chamberlin, in press).

We’ve also opined on the threat to recovery oriented system planning inherent in the implementation of evidence-based practices and perfect model replication (O’Brien & Anthony, 2002). Other publications, including this news brief, have focused on these issues and other concerns related to recovery implementation, such as the workforce, funding, legislative support, advocacy, etc. However, if I had to emphasize a variable that is within everyone’s control, yet if poorly implemented becomes an impossible obstacle to state wide recovery initiatives, I would have to stress statewide leadership with respect to the implementation of recovery.

In an attempt to examine state mental health policies and practices that promote recovery, Kathy Furlong-Norman and her colleagues at the Boston University Center for Psychiatric Rehabilitation conducted focus groups and implemented a brief survey instrument with selected state mental health commissioners and consumer administrators in state offices of consumer/recipient affairs. She reports that commissioners clearly identified that their leadership as "change agents" and bearers of public policy and values is an important factor in shaping recovery policies and practices. In addition, the data indicated that the commissioners emphasized the importance of carrying the "leadership mantel" with respect to recovery.

Statewide leadership is so fundamental because the vision of recovery is foreign to what has been masquerading as the mental health vision for the last century. Prior to this vision of recovery, the mental health system had no consumer-based vision, i.e. no vision that focused on what the consumer might get out of the system. Prior visions (using the word ‘vision’ loosely) emphasized the location of the services (institutionalization, deinstitutionalization, community support systems) or the breadth of the services (continuity of care, comprehensive services) but not the outcome for the person receiving the services.

NASMHPD/NTAC e-Report on Recovery – Fall 2004

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