Thursday, June 01, 2006

Recovery and coercion

The American Association of Community Psychiatrists (AACP) Guidelines for Recovery Oriented Services note that "recovery has been variably defined" and that "[t]he use of coercive measures for treatment is not compatible with recovery principles."

SAMHSA (Substance Abuse and Mental Health Services Administration) defines “recovery” in its Consensus Statement in a way that appears to foreclose the possible compatibility of recovery and the use of leveraged treatment. The first of its ten ten fundamental components of recovery is self-direction: "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."

This perspective on recovery dashes all hope of rescuing those who are refusing treatment – it erects one more barrier to treatment for clinicians who are already facing too many obstacles. The most discouraging aspect of the SAMHSA formulation of recovery is that an organization that purportedly promotes an "evidence-based approach" has apparently ignored research demonstrating that the use of leverage is both necessary and beneficial for a small group of individuals with the most severe mental illnesses.

The debate about leveraged care, which promises to continue to rage, should be an informed rather than an emotional one. An informed review of relevant data shows that the practice of rescuing people with leveraged treatment can be entirely compatible with, and sometimes necessary for, recovery.

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