I was recently asked to write an article for SAMHSA’s Recovery to Practice newsletter. This is a slightly edited version of that post.
Let me be clear: I was never anti-recovery. I will admit, however, that when the recovery movement first came to my attention in the 1990s, I was not drawn in. Whenever I attended a presentation on the topic, rather than being able to listen openly to the speaker, I felt defensive. At the time, I was working in a state that was pushing hard to close its state psychiatric hospital. While the mantra was of recovery, it seemed to be promoted by fiat. Since people were expected to recover, therefore, we did not need a state hospital.
A consequence of this assumption was the expectation that my colleagues and I would know how to help those who were referred to us live safely within our community. Simply saying that recovery is possible did not magically transform the lives and minds of individuals who were clearly struggling. For a long time, therefore, I viewed the recovery movement as merely a slogan rather than a helpful or instructive practice.
Fast forward to today. As I meet recovery movement leaders, I find myself listening to what they have to say in a new way. I have learned many things, but perhaps the key lesson is that the power differential inherent in the “doctor–patient” relationship distorts my connection with the person in my office. Furthermore, the opportunities to listen to people who have experienced being “psychiatric patients” are invaluable. Their stories of recovery have prompted me to examine the myriad ways in which I—in my earnest attempt to be helpful—may be undermining the person’s autonomy and sense of agency.
The most compelling experience that crystalized the power of a recovery approach comes from my own clinic. Several years ago, after Hurricane Irene shuttered Vermont State Hospital, a long-standing debate over the hospital’s fate was suddenly moot. Clinics like mine were asked to develop programs that might prevent people from requiring hospitalization. Our crisis program tended to see people a single time and then refer on – to outpatient treatment, hospital, etc. I wondered if some of these individuals could be helped if we extended this crisis intervention from one of evaluation and referral to include more extended support. We created a team, START – Stabilization and Recovery Team -modeled to some extent on Open Dialogue, which was pioneered in Tornio, Finland. Members of the team respond to a person in crisis; they work in teams, see people in their homes or in the community, and follow them through the crisis.
At the time we were creating START, there was a suggestion from Vermont’s Department of Mental Health to integrate people with lived experience into our community crisis services so we decided to hire mostly peers to work at START*. This was a leap for us. We wondered if we could find people to fill these roles, if they would know what to do, if they could tolerate the stress. The team has evolved over the four years it has been in existence and we have all learned and grown through this process. Recently, a person with lived experience became the director of the program. The team receives referrals from many clinicians who work for our agency but anyone in our county can refer to them. They typically work with people for several weeks. The most critical aspect of their work is that they share their own stories openly. Most have been trained in Intentional Peer Support. So while the Open Dialogue model informed the structural design of the team, IPS is a foundational element of the work they do. I work with them and I bring my own perspective and dialogic orientation to our meetings where we also try to involve the individual’s social network.
The peers have taught me so much. I understand that as professionals we often – intentionally or not – are in the position of being the experts who are going to fix the problem. This brings a sense of hierarchy into the relationship and, if we are not careful, will result in us not fully appreciating the person’s strengths and abilities. This kind of relationship can diminish a person’s sense of agency – the notion that he or she has the ability to see the problem through. With humility, I realize that even on my best days, a peer can offer something that I cannot. These simple words, “I have been there and made it through,” are potent indeed. START is incredibly responsive to staff and clients; they rarely turn down referrals. Satisfaction with the program is high. For these reasons, they are incredibly popular among both clients and staff
Beyond that, I have witnessed the transformation of the team members. START itself has been a recovery force for the team. A number of peers have entered the work force after living for years on disability insurance — first as substitutes, and then as regular staff members. Some have gone on to full-time employment or return to school. Our clients look up to the team as role models and the team has influence within the clinic as well. Practitioners who did not think peers could be effective are now among our most ardent supporters.
It has been humbling, instructive, and inspiring to work as a member of this remarkable team and to be part of our collective journey of discovery and recovery.
*A friend and colleague has recently challenged the use of the word “peer.” While I accept and understand her objections, I am using this term here to mean both someone who has lived through a so-called mental health crisis and is willing to share that experience.