Recovery in the USA: From politics to peer support

Abstract

Efforts to transform the mental health service delivery system to a more consumer-driven and recovery-orientated approach has its roots in a somewhat radical anti-psychiatry and civil-rights movement dating back to the 1970s. This grass-roots effort gained momentum and credibility with Harding’s landmark study published in 1988 followed by the work of Anthony et al. from Boston University in beginning to define the term ‘recovery’ In 1998 the Office of the US Surgeon General issued its first report on mental health, and this critical view of the shortcomings of the existing service system set the stage for the 2003 President’s New Freedom Commission and its recommendations for recovery-orientated systems transformation. The recovery movement has evolved from a more radical view in the early days, to participatory involvement in systems, to returning to alternative models of care that are more independent. Now as more peer specialists work in systems, there is an increased emphasis on non-medical alternatives and the cycle continues. Regardless, recovery, self-determination, choice, etc. are always at the centre. This paper notes the interesting cycles of recovery-orientation and how they spin around the values/tenets of the movement’s early roots.

Participatory Spaces of Mental Health Service User Organizations in the Post-deinstitutional Era: Mapping Roles and Challenges

“…The challenges and value conflicts arising from developments in the role of MHSUOs are frequently described in the included texts (Boyce et al 2010;Gillard et al 2016;Nelson et al 2008;Ostrow and Adams 2012). We argue that these challenges are related to how MHSUOs in the post-deinstitutional era simultaneously participate in social processes related to popular, claimed or invited spaces.…”

“…Some argue that this could be seen as a radical development, where MHSUOs have claimed participatory spaces by creating alternatives to traditional mental health services based on service users' needs and knowledge. Others describe the associated dangers of professionalization, cooptation and less focus on political advocacy (Andersen and Svensson 2013;Ostrow and Adams 2012;Seebohm et al 2010). These developments can furthermore cause role conflicts as MHSUOs straddle dual identities as partners with and opponents to traditional service systems (Crossley 2006).…”

“…Karlsson and Markström (2012) discuss this trend as a Faustian pact whereby organizations gain influence and resources by receiving public grants and contracts in return for delivering services. However, these very opportunities risk changing the key values of organizations (Karlsson and Markström 2012;Ostrow and Adams 2012). While professional partnerships can contribute to greater organizational capacity, they can also result in decreased service user control and a more formal and hierarchical organization (Salem et al 2008(Salem et al , 2010.…”

“…However, several texts raise questions of whether concepts and perspectives such as empowerment and recovery could become coopted when incorporated into the professional system (Adame and Leitner 2008;Ostrow and Adams 2012). Adame and Leitner (2008), for example, discuss how empowerment has changed so as to mean individual choice over treatment rather than the redistribution of power resources.…”

“…MHSUOs have also struggled for service user participation by advocating for the integration of service user knowledge and perspectives in mental health service systems (Ostrow and Adams 2012). These efforts not only relate to MHSUOs gaining access to spaces of policy making, but also to service users challenging the hegemonic discourses of these spaces by articulating alternative perspectives.…”