Promotion of the Recovery Model
The Community Support System (CSS) vision is one of hope and was
founded on the assumption that people can live successfully in the community if they are
offered an adequate array of supports (Anthony, Cohen and Farkas, 1990; Parrish, 1994).
The service array is organized into a network that, ideally, surrounds the client with
everything he or she needs to live up to his or her potential: client identification and
outreach, mental health treatment, crisis services, medical and dental care, housing,
income maintenance, family and community support, rehabilitation services, protection and
advocacy, case management, and peer support (Stroul, 1989).
The CSS philosophy is guided by a set of key principles about service
delivery. According to this philosophy, services should be: (1) consumer-centered; (2)
empower clients; (3) racially and culturally appropriate; (4) flexible; (5) focus on
strengths; (6) normalized and incorporate natural supports; (7) meet special needs; (8) be
accountable; and (9) be coordinated (Stroul, 1989). Evaluation research suggests that the
CSS approach works well (Anthony, Cohen and Farkas, 1990; Anthony, 1994) when adequately
planned and funded (Parrish, 1994).
Moxley and Mowbray (1997) point out that the original CSS model
underemphasized the inherent value of self-help. They suggest, though, that nontraditional
services have now taken on an increased importance precisely because of the fact that
community support is intended to serve people where they live and when they need it.
Traditional services are simply not flexible enough to accommodate these kinds of requests
for assistance.
The full emergence of consumer roles in the provision of behavioral
health services, which has occurred in the 1990's, represents fruition of a number of
trends operative throughout the modern history of services to persons with psychiatric
disabilities. These include empowerment as a social intervention (Rappaport, 1984), the
Independent Living Movement (Deegan, 1994), the high value placed upon consumerism within
community support initiatives (Stroul, 1989), the recognition that a number of important
helping functions may be performed by persons other than those with traditional
professional training (Anthony and Farkas, 1990) and the acceptance of the concept of
recovery (Anthony, 1994; Deegan, 1994).
The feasibility and value of persons with psychiatric disabilities
performing as providers of services has been demonstrated. As well as successfully
performing some roles traditionally performed by persons with professional training,
persons with psychiatric disabilities have demonstrated the willingness and ability to
perform services not successfully offered by professionals (Mowbray, Chamberlain, Jennings
and Reed, 1988). Such programs meet important needs.
Results of demonstration projects wherein consumers have served in
provider roles have shown that benefits accrue to both consumer-deliverers and
consumer-recipients of services. Benefits identified for recipients include more
"normalized" relationships within the helping process (Armstrong, Korba and
Emard, 1995), based upon the similarity of helper-recipient backgrounds, as well as an
increased empathy brought to the helping relationship by consumer-providers.
Benefits to consumer helpers, beyond the obvious benefits of improved
vocational status and on-the-job training, have included the psychosocial benefits of
autonomy and confidence which this involves (Mowbray, Moxley, Thrasher, Bybee, McCrohan,
Harris and Clover, 1996). Other benefits (Mowbray et. al, 1988) involve improvements in
interpersonal effectiveness as well as social approval. Services utilizing consumers as
providers have demonstrated productivity, diversity and performance, which is cooperative
with the community and professional providers.
In a typology of consumer roles (Mowbray and Moxley, 1997),
consumer-run alternatives are identified as those in which both the dimensions of
consumers-as-providers and control of the services are present. There are particular
advantages to consumer-delivery of services within programs under the control of
consumers. Free of many structural restraints inherent in traditional programs, programs
controlled by consumers are able to create service alternatives not achievable by formal
mental health services. Being in control of the program development structure enhances
consumers' capacity to implement alternatives more easily. Also, because services are
developed and delivered by consumers, their contribution is unique and different from what
professionals in rehabilitation and community support are able to deliver.
The environmental context in which the mental health system belongs
includes both political and economic forces that impact the course of treatment (Anthony,
Cohen and Farkas, 1990). Huge federal deficits accompanied by continued public
misperceptions about mental illness have encouraged political leaders to, shortsightedly,
underestimate the value of community-based treatment. Parrish (1994) points out that while
hospitals serve less and less people, they continue to absorb disproportionate amounts of
state mental health budgets.
It becomes doubly important in an environment of scarce public
resources to demonstrate the effectiveness of services - Evaluation tools must be used to
direct services to what works in order to legitimize requests for the kind of support
thought to be most appropriate (Campbell, 1996). The entry of managed care into behavioral
health presents self-help programs with new challenges and opportunities. It is imperative
that managed care organizations be promptly brought up to speed on the unique
contributions that consumer-run programs provide (Van Tosh and del Vecchio, In Press).
Anthony (1994) suggests that recovery is firmly grounded in the
philosophy of deinstitutionalization, and he defines it as "a deeply personal, unique
process of changing one's attitudes, values, feelings, goals, skills, and/or roles."
Deegan (1994) sees recovery as a three-pronged process: the expression of hope, the
willingness to try and the discovery that you can do and be again.
Anthony, Cohen and Farkas (1990) cite six pitfalls in current mental
health planning: (1) lack of values: (2) lack of focus on client goals; (3) lack of focus
on client's perceived needs; (4) lack of focus on preferred level of intervention; (5)
lack of substance; and (6) lack of hope.
Many people, both inside and outside the mental health system, still do
not accept the reality that people with serious mental illnesses can and do recover (Ruth,
1994). While we cannot force someone to recover, we can provide the kinds of supportive
environments that are more likely to allow the process to work (Deegan, 1994). Parrish
(1994) too calls for a change in people's assumptions and suggests that hopeful
expectations inevitably lead to better results: more clients will get the chance to find
satisfying lives, more people will be drawn to rewarding jobs in mental health, more
leaders will come to understand what works, and more dollars will be directed to programs
that make a difference.
A system that is truly recovery-oriented should scrutinize each
essential service in light of its potential impact on recovery (Anthony, 1994). It is
suggested that such a system should operate under the following assumptions: (1) Recovery
can occur without professional intervention; (2) people who recover have people who stand
by and believe in them; (3) recovery can occur whether one sees mental illness as
biological or environmental; (4) recovery can occur even though symptoms may reoccur; (5)
recovery often changes the frequency and duration of symptoms; (6) recovery is not a
linear process; (7) recovering from the consequences of being ill is often more difficult
than recovering from the illness itself; (8) recovery does not mean that one did not have
a mental illness (Anthony, 1994).
