Two-Way Street Crucial to Fostering Recovery

Although psychiatrists may face barriers such as limited time or lack of training about recovery principles in their quest to help patients recover from serious mental illness, they can empower themselves—much in the same way they empower their patients—to overcome these barriers.

This was the hopeful message from a consensus conference held in Philadelphia in January 2006, the outcome of which appeared in a report in the August Psychiatric Services.

At the meeting, 24 community psychiatrists convened to discuss the barriers to recovery they have encountered in practice and consider ways to promote recovery in their patients.

Three major consensus points they reached involved the need to enhance psychiatrists' knowledge of recovery, the need to redefine their roles in ways that support their efforts to promote recovery, and the need to invest in recovery-oriented training throughout their careers.

One of the problems identified by psychiatrists at the meeting was that they had only a vague sense of the principles of recovery and that“ those providing clinical supervisions or working day to day with patients had little training and too few opportunities to learn about recovery and its implications for their work,” their report stated.

The meeting participants also believed that too few public mental health programs emphasize the tenets of recovery—empowerment, employment, and education—so that psychiatrists do not always know where to refer patients for help in these areas.

According to Mark Salzer, Ph.D., one of the article authors and an assistant professor of psychiatry at the University of Pennsylvania, psychiatrists at the meeting had a sense that there were few recovery guidelines available for them to use in their daily work with patients.

Another problem identified was that they have limited time to work with patients and perceive little opportunity for more in-depth interactions with patients. According to Salzer, they remarked that psychiatry's leaders have not done enough to “promote the importance of recovery within the field,” and he noted that current reimbursement systems do not support recovery.

In addition, participants noted that there were no standardized methods of assessing the effectiveness in achievement of recovery-oriented goals.

Some of the problems identified stem from a lack of funding in the public mental health system and from injustices such as stigma toward people with psychiatric problems.

Psychiatrists at the meeting voiced a need for “more substantial funding for a wide range of rehabilitation programs that respond to recovery-oriented goals.”

They suggested a number of ways to overcome the problems they identified and thus help patients lead more meaningful lives. They recommended that psychiatrists be systematically educated on the principles of recovery, for instance, and that the field develop best-practice guidelines that emphasize a range of approaches to support patients' progress toward recovery (see“ Original article: Promoting Recovery: Recommendations for Psychiatrists”).

Psychiatrist Anita Everett, M.D., helped organize the meeting and participated in the discussions. “It is critical that all psychiatrists in community practice fully understand the value of working with consumers from a recovery paradigm,” she told Psychiatric News.“ Preparing psychiatrists to be well-equipped to work in contemporary mental health centers is essential for our profession to thrive.”

Everett is section director for community and general psychiatry at Johns Hopkins School of Medicine in Baltimore.

She noted that psychiatrists have moved from a more “custodial-care era” to one in which there is increased emphasis on community integration and consumers' participation in their own wellness and recovery.

The tools already available to psychiatrists include new medications that are better tolerated than medications in decades past and a more sophisticated knowledge of effective psychosocial rehabilitation and support services, Everett said.

“My favorite shorthand for recovery,” she said, “is the Home Depot tag line, 'You can do it. We can help!' ”

An abstract of “Barriers to Recovery and Recommendations for Change: The Pennsylvania Consensus Conference on Psychiatry's Role” is posted at<www.psychservices.psychiatryonline.org/cgi/content/abstract/58/8/1119>.▪