Deborah Brauser
December 28, 2011 — After considering more than 1,400 comments during a public feedback period this summer, the Substance Abuse and Mental Health Services Administration (SAMHSA) has released a new working definition of "recovery" from mental disorders and substance use disorders.
The organization began consulting members of the behavioral healthcare community more than 1 year ago to develop both major guiding principles and a definition that would capture "the essential, common experiences of those recovering," they write.
The new definition, which was published on SAMHSA's Web site on December 22, now states that recovery is a "process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential."
"Over the years it has become increasingly apparent that a practical, comprehensive working definition of recovery would enable policy makers, providers, and others to better design, deliver, and measure integrated and holistic services to those in need," Pamela S. Hyde, SAMHSA administrator, said in a news release.
"I believe SAMHSA has achieved a significant milestone in promoting greater public awareness and appreciation for the importance of recovery, and widespread support for the services that can make it a reality for millions of Americans," added Ms. Hyde.
Public Feedback
In August 2010, SAMHSA invited "mental health consumers and individuals in addiction recovery" to a meeting to discuss the need for a new definition of recovery as part of its Recovery Support Strategic Initiative. There, the participants developed the first draft of a definition as well as a draft of guiding principles of recovery.
Over the following 12 months, SAMHSA worked with other participants at meetings and conferences to clarify and revise the drafts. The first official working definition and principles were then posted on a Web site blog in August 2011, along with an invitation for public feedback.
The initial blog post received 287 comments, with more than 1,200 additional comments left on SAMHSA's Feedback Forums.
Altogether, 1,000 participants left comments; the participants included representatives from organizations such as the National Alliance on Mental Illness (NAMI) and the National Association of State Alcohol and Drug Abuse Directors (NASADAD).
NAMI and NASADAD Respond
"SAMHSA's 10 'Guiding Principles of Recovery' are laudable as a vision to aspire to," Michael J. Fitzpatrick, executive director of NAMI, wrote at that time in one of the blog's comments. "Unfortunately, these principles fail to acknowledge that some people living with the most serious mental illnesses are sometimes limited or unable to exercise self-determination."
He added that neglect or lack of treatment can lead to "horrendous consequences," including large numbers of those with mental illnesses being incarcerated in jails and prisons, "boarded" in emergency departments, or becoming homeless.
"The solution to these problems is a system that is individualized, respectful, allows people to exercise personal choice and autonomy whenever possible, but also has the capacity to intervene and provide humane, compassionate assistance to people when they most need it," wrote Mr. Fitzpatrick.
He also suggested that the important role families play in helping adults living with mental illness should be acknowledged and that the guidelines should emphasize that recovery means different things for different people.
Robert I. L. Morrison, executive director of NASADAD, wrote in his comments that more work should be done in understanding current state-funded recovery services and that SAMHSA should draw from states' experiences with the various Access to Recovery models already implemented.
"In addition, we agree there are commonalities between recovery from mental and substance use disorders that are important to understand, particularly in the context of reimbursement strategies," wrote Mr. Morrison.
He added that it should also be acknowledged that recovery experiences may be different for these people.
SAMSHA noted that many of these comments have been incorporated into the current working definition and principles.
"The response to our request for feedback was tremendous and clearly demonstrated the field's interest and concern on this important issue. Over 8,500 votes were also cast in support of the ideas on the forums," they write.
New Guidelines
The new guiding principles now state that recovery:
- emerges from hope;
- is person-driven;
- occurs through many pathways;
- is holistic;
- is supported by peers and allies;
- is supported through relationships and social networks;
- is culturally based;
- is supported by addressing trauma;
- involves the individual, family, and community; and
- is based on respect.
Along with the definition and principles, SAMHSA has also created "4 major dimensions that support a life in recovery," consisting of health, home, purpose, and community.
Further, they added a preamble emphasizing that "there are many different pathways to recovery, and each individual determines his or her own way."
SAMHSA notes that although several effective models exist for promoting recovery, more work is needed to make sure services and systems are put into place in every state.
"Drawing on research, practice, and personal experience of recovering individuals, within the context of health reform, SAMHSA will lead efforts to advance the understanding of recovery and ensure that vital recovery supports and services are available and accessible to all who need and want them."
The full report was published online December 22 on SAMHSA's Web site.
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