If we want to look a little closer for evidence of having a Recovery Oriented System of Care, we have to know a little more about what Recovery actually looks like. For that, we go to Practice Guidelines for Recovery-Oriented Behavioral Health Care published by the Connecticut Department of Mental Health and Addiction Services (Tondora and Davidson, 2006). This is what they have to say about promoting access and engagement in a Recovery Oriented System of Care.
The duty to promote access and foster engagement is anchored to a core principle of the deinstitutionalization movement of the 1950s that reminds us that individuals with a serious mental illness should be able to receive services in the least restrictive setting possible in their home community. One’s ability to obtain mental health care is often limited by a number of factors; lack of focus on engagement processes, consumer avoidance of helping systems as a result of painful or ineffective treatment histories, rigid programmatic structures that result in a failure to establish relationships and poverty or homelessness made worse due to the experience of mental illness.
The Surgeon General’s Report on Mental Health (DHHS, 1999) suggests that for each person that seeks and receives mental health services, there are two other individuals with a similar diagnosable psychiatric disorder who will neither seek access nor receive effective treatment. This report was amended in 2001 by a supplement on race, ethnicity, and culture that observed that the lack of access to specialty mental health services is an even more formidable obstacle to treatment for persons of color.
Access to Care
Access to care is more complicated than determining service eligibility. Access to care is determined by how we facilitate the swift and uncomplicated entry into services. Access to care may be improved by working harder with outreach efforts, enacting a policy of “No Wrong Door” to gain entry to services, and by making sure that information about services is made available and understandable through public education and information, active networking with community partners, and linking to self-help groups with common interests.
Access to care is closely related to engagement. Successful engagement asks us to see the person instead of, or despite, the presence of a disabling condition. Successful engagement works to build trust over time so we can link the person to relevant services and resources that make a positive difference for them. Perhaps most importantly, successful engagement hinges on the ability to encourage rather than coerce and resolves the power differential at the core of every helping relationship. Engagement is defeated by intimidating or unwelcoming physical environments and by overly complicated procedures or barriers to scheduling.
When we promote access and engagement, we might hear, “I hated going to that place at first.. Everybody looked at me as I walked up the block like ‘ if he’s a patient there he’s gotta be on dope or crazy’. So, I just never went. But they came to me on my own turn and on my own terms. Today, I think my case manager is the main reason I’m still alive.”
“They knew when to take no for an answer. They didn’t stay on my back all the time but I knew they were always there for me if I needed them. Now I don’t say ‘No’ so often.”
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