Mental Health Recovery--Patient Directed Care

Just a quick post today. I thought we'd take a break from the topic of substance use disorders and talk a little bit about mental health. This is going to be the first in a series of posts on the Mental Health Recovery Movement. As a mental health worker, I practice within a Mental Health Recovery Framework. The Substance Abuse and Mental Health Services Administration (SAMHSA) states that:

Mental Health Recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.

I like to think of this as bringing a person's overall level of functioning up to the best it can be. And this can sometimes require serious help from many different sources. But one pillar of recovery has to do with patients directing their own treatment.


The first time I ever met a person with schizophrenia it was a patient at the Veterans Administration. I was sitting in with the Psychiatrist while he assessed her. She was a long-time patient who came into the VA once every year to her her annual physical and meet with the doctor. She refused to take any medication, and had active auditory hallucinations and paranoid thoughts. However, she informed the doctor that she had been taught to always keep her appointments with the psychiatrist because she had to take care of her mental health as well as her phsyical health. No one was going to force her to take medications, but she remained plugged in with services so that if there were some kind of crisis she would be able to get help. The doctor didn't try to hard-sell her on meds, have her hospitalized, or demean her choices. He documented her symptoms, informed her of her options, and left the direction of her treatment up to her. And because he treated her this way, with respect, she kept coming back, year after year. She got appropriate health care. She knew what to do if she felt like hurting herself. Her level of functioning was better than it would have been if she was afraid to come in because someone was going to try to force her to do something she didn't want to do. Also, there is a chance that by building this trust over time, she will eventually trust the doctor enough to try medications despite the paranoia (a symptom of her mental illness) she experiences.

Why is it so important that a person's treatment be self-directed and individualized? Because, it's empowering in a situation where a person may have gotten messages that they're broken, sick, and disabled. They may feel out of control and hopeless. Respecting a person's right to be active in choices regarding their treatment returns a sense of agency. And as they get better, they get to fully own each and every win because they were active in their treatment planning. Professionals didn't help them. They worked with professionals and peers to help themselves.

Think about how this might apply in your own life with people you know who are struggling with mental health issues. Think about how it might have affected you if you saught out help for your own mental health. It's rare that it is appropriate to mandate treatment for a person against their wishes. Those exceptions usually have to do with safety. This includes times when a person might be actively suicidal or thinking about harming other people. But these types of situations are more the exception than the rule. If you seek out treatment for mental health, you have the right to be heard. You have the right to an array of treatment options, and you have the right to choose what you're comfortable with. I encourage you to do your research, be an informed consumer, and maybe even try things that are scary or uncomfortable, but ulitmately the choice is yours.

What are your thoughts on this? Do you have questions? Let me know if the comments, or drop me a line.