Monday, April 03, 2006

Mental health recovery

Recently, SAMHSA released a National Consensus Statement on Mental Health Recovery that identifies 10 fundamental components necessary to achieve mental health recovery. While the statement is filled with hope, it neglects an important, but often neglected group of people with severe mental illnesses. According to the explanation for the first component, self-direction means that:

By definition, the recovery process must be self-directed by the individual, who defines his or her own life goals and designs a unique path towards those goals.
Yet, research shows that competence to make decisions about treatment may be problematic among people with serious mental illnesses. If decision making is so compromised that an individual is incapable of making safe choices about treatment, is it right to encourage self-direction? Can the principles of recovery be reconciled with the need to use leveraged or mandatory care in some circumstances?

Some very thoughtful authors have tried to address this apparent inconsistency and proposed to “broaden the concept of patient-centeredness to include mandated care under certain circumstances. … [U]sing incentives and disincentives to facilitate and promote adherence to treatment is patient-centered care to the extent that these interventions are experienced by patients as being grounded in a caring therapeutic relationship.” See Mandated Treatment in the Community for People with Mental Disorders.

Read more on the Ethics of Mandatory Community Treatment.