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Whole Health Care Part 2: Evolution of Recovery-oriented
Practices
with Wesley Sowers, M.D.
and Renee Kopache, M.S., C.P.R.P.
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SAMHSA’s Vison for Recovery to Practice
Through education, training, and resources the Recovery to Practice
(RTP) program supports the expansion and integration of recovery-oriented
behavioral health care delivered through multiple service settings.
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Recovery in Behavioral Health
A process of change through which individuals improve their health and wellness,
live a self-directed life, and strive to reach their full potential
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SAMHSA’s 10
Components of Recovery
in Behavioral
Health
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RTP Training and Technical Assistance
Recovery-oriented Behavioral Healthcare
RTP Newsletter
Sign up: [email protected]
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Wesley Sowers, M.D. University of Pittsburgh Medical Center, and Center for Public Service Psychiatry of Western Psychiatric Institute and Clinic Renee Kopache, M.S., C.P.R.P. Hamilton County Mental Health and Recovery Services Board Cincinnati, Ohio
Evolution of Medical Care
• Shifts in medical care
• Forces dictating these changes
• Dissatisfaction
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Evolution of Health Care
Why were they respected and
effective?
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Evolution of Health Care
Why were they respected and
effective?
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Sources of Change
• Scientific advances • Pharmaceuticals • Laboratory tests • Health insurance
industry
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• Health care as private enterprise • Productivity pressures • Administrative expenses • Profit a necessity of providing care
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Impact on Physicians
• May encourage a trend toward specialization
• Idealism and service orientation harder to fulfill
• Time constraints • Pharmaceutical influences
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Impact on Psychiatry
• Conformity to other medical specialties
• Scope of training and skills • Heavy reliance on
medication and biologic treatments
• Impact on relationships with clients
• Focus on diagnosis rather than health
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Technology Oriented Care
• Emphasis on technology, diagnosis and biologic treatment: objectivity
• May influence a stance that is more impersonal
• More directive, paternalistic, and detached
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How Do We Really Practice Medicine?
• The technology orientation is an extreme vision
• Humanism alive and well in medicine!
• Failure to articulate an alternative vision
• Return to our roots
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Enter Recovery
http://store.samhsa.gov/product/Achieving-the-Promise-Transforming-Mental-Health-Care-in-America-Executive-Summary/SMA03-3831
http://iom.nationalacademies.org/Reports/2001/Crossing-the-Quality-Chasm-A-New-Health-System-for-the-21st-Century.aspx
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The Evolution of Recovery
• Segregation v. Assimilation • Fear v. Empathy? Risk
management prioritized • Prejudice, separation and
alienation • Recovery supporting
approaches: the moral treatments of the 19th century
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Coining the Term
1930’s • Founding of Alcoholics
Anonymous • Teachings of Abraham Low
1950’s • Twelve-step programs grew
apart from professional leadership
• Recovery, Inc. in collaboration with professionals
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Twelve-step Recovery
Incorporation into
professional approaches
Mentoring
Mutual support; community Personal responsibility
Acceptance; welcoming
Hope
Restructured thinking
Blueprint for living
Dramatic growth
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Recovery in Mental Health
• Re-emergence; recognition • Consumer/survivor civil rights
advocacy • The bio-psycho-social view (Engel)
• Psycho-social rehabilitation approach (Anthony and Lieberman)
• The rise of community psychiatry • Peer-delivered services
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Recovery Today
Transformative process in behavioral health
Melding twelve-step and mental health recovery
Recognition of universal aspects of recovery
Hope, autonomy, community: pillars of growth and fulfillment
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Recovery-oriented Care
Healing Empowerment
Hope and Purpose Strength and Health
Connectedness and Community Relationship
Spirituality and Faith
Personal Role
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Technology-oriented and Recovery-oriented Care
• Healing prior to technologic advances are strikingly similar to recovery-oriented care
• Relationship-based care and community service remain as major reasons attracting people to medicine today
• Technology can serve these ideals if used properly
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The Future of Psychiatry
• A new vision • Relational aspects of care • Strength of hope and belief
in healing • Role of advisor, coach,
partner and friend
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Integrative Care
Interaction of body and mind
Health is critical
Recovery planning includes health
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A Place for Technology • Understand its strengths
and limitations
• Technological advances and medications have had significant impact for many
• When used appropriately they can have a important role in the healing process.
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Recovery-oriented Use of Medication Medication use is a personal choice (with very limited exceptions)
The successful use of medication requires the sharing of information and decision making
It requires flexibility and the assumption of some risk
Medication is a tool - not the solution It is one of many tools for recovery
Shift from symptoms, illness, and medication to WELLNESS and
the WHOLE PERSON
Shifting Focus
Keris Jän Myrick, 2013
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Collaborative Decision Making
Fosters trust
Creates investment
Promotes self-reliance and responsibility
Opportunity to learn
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Process for Shared Decision Making
Objectively evaluate individual’s experience
Clarify individual’s goals for change
Consider possible interventions
Examine pros and cons of each
Select, implement and evaluate choices made
Evaluate Medication Options: Individual Priorities
• Is it important not to feel sedated while driving or for night time child care?
• Can medications help alleviate symptoms that are barriers to goals (e.g., work, school, etc.)?
• Does he/she want to eliminate symptoms with a high dose, or would he/she rather start with a low dose and tolerate some symptoms? Can non-medicinal tools/strategies help at the same time?
Ron Diamond, MD
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Challenges
Time Constraints
Challenges to Establishing Trust
Cognitive/emotional impairment
Emphasis on medication management
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Making the Most of Short Visits
Pre-visit questionnaires
Collaborate with others
Take time for relationship
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Summary
Medications are one of many important tools in a recovery toolkit
People in recovery ultimately decide how meds are used
Our challenge is to educate, support and guide
A collaborative approach is key
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Part of the Whole
• Recognize that doctors cannot work effectively in isolation
• Multi-dimensional approach needed
• Partnership with other professionals and natural supports critical for success
When ‘I’ is replaced by “we,”
even “illness” becomes
“wellness.”
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Contacts
Wesley Sowers, M.D.
Renee Kopache, M.S., C.P.R.P. Hamilton County Mental Health
and Recovery Service Board [email protected]
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Coming up!
• September 9 - Health Care Reform and Recovery
We’d like to hear from you! What webinars topics would you like to see
next year?
Let us know at [email protected]
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below in the link box. 42
