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June 28, 2012 Volume 3, Issue 24
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Call for Papers


RTP is calling for personal and practitioner articles, artwork, photography, and videos that illustrate the principles and potential of recovery. Whether they describe how self-directed care has changed the nature of your practitioner–client relationship, your journey of healing and recovery, a recovery-oriented tool or strategy, or how peer involvement has influenced your workplace, your stories deeply touch our readers and continue to advance the mission and values of Recovery to Practice.

To submit an article or recovery resource, please contact us at 877.584.8535, or email recoverytopractice@dsgonline.com.

Use of the Term 'Mental Illness'
by Charles Weinberg, LICSW, BCD
How do we feel about use of the term "mental illness"? The phrase is prevalent in mental health and may continue to be broadly used for quite some time. To the extent that its use destigmatizes (because it can mean "I am not crazy" and "I am not bad"), it is a good thing. To the extent that it validates the uniqueness of someone's experience and helps providers be empathetic, it is a good thing. To the extent that it helps find statistically valid and empirically confirmed biochemical or genetic aspects of mental health problems to create a wider range of effective treatment tools, it is a good thing.

But the New Freedom Commission and Uniformed Services Package say mental health care must be transformed to reflect the principles of the Recovery Model. We know there are several key aspects of the Recovery Model:
  • Stigma is a prominent concept in the Recovery Model, but it is also a major cause of nonadherence. Individuals who have a full range of mental health challenges say they want to be seen as people—not as a problem and not as an illness. They do not want to be labeled.
  • Rehabilitation is another fundamental concept. Our job as providers is to encourage, educate, and empower veterans and others with mental health difficulties to do the work necessary day after day—for as long as needed—to maximize their potential for recovery.
  • The Recovery Model is intended to be strengths based.
  • A need to empower the client in the treatment process and seek client feedback, because a client's perception of the therapeutic relationship is a strong predictor of treatment outcomes.
We know that language matters. The term mental illness derives clearly from a neurobiological approach, which often deemphasizes psychosocial issues—the very issues that drive and affect the valued life goals of those we serve. When treating a "mental illness," rehabilitation can be marginalized by care providers (focusing more on medicine than the therapeutic relationship) and care receivers (showing up only for a script, or with a fixed narrative of "being sick," which can lead to the "why try" syndrome). Use of the term mental illness can contribute to a clouded view, where care providers and receivers see most things through the lens of a dysfunctional label. It tends to create a false mutually exclusive dichotomy of "normal" and "mentally ill," as opposed to the reality of a continuum of mental health functioning, where all people struggle to some degree, but with a varying range of impairment. Use of the term mental illness emphasizes the need for treatment that identifies and then ameliorates negative symptoms, as opposed to the teaching of coping skills and facilitation of wellness in a more holistic, recovery-oriented, and strengths-based approach.

Use of the term mental Illness is consistent with the reality and problems/benefits of psychiatric diagnosis. Diagnosis is supposed to stem from an objective nosology that tells us how to treat and help people with mental health problems. But diagnosis also labels and contributes to stigma. Diagnosis can be laden with values (homosexuality used to be represented in the Diagnostic and Statistical Manual of Mental Disorders [DSM]). It can be subjective, as there are problems with interrater reliability (schizoaffective disorder will not be in DSM–5, but how can a true "mental illness" disappear?).

Treatment outcomes are determined by three sets of variables—yes, variables within clients, but also variables in systems, providers, and relationships. Do we spend equal time on these issues, or disproportionate time dwelling on diagnostic reasons and labels—issues that are beyond our control? Perhaps we should spend more time on the issues we can control, such as those involving providers and relationships. If we want to be evidence based, don't we have to look at all of the evidence (even the hard part of looking in the mirror)? Although clients make their own decisions (and the idea is not to take ownership for their actions or set unrealistic expectations for ourselves as providers), in the parallel process of self-improvement, we as providers have to model what we are encouraging and teaching.

Now I have a confession to make. Just a few short years ago, I was the guy who would confront the client like heck and try to bust through his resistance. When he would eventually drop out, I'd claim he didn't want my help anyway. Today I understand the need to meet people where they are at, in addition to being direct and specific with my best clinical recommendations. It also helps if I roll with resistance, validate clients' right to make choices I do not agree with, and model acceptance of what cannot be controlled, regardless of diagnosis or severity of the presenting problem.

So, more often than not I find myself using the term "mental health problems" and not "mental illness," because in my opinion it better represents reality and is likelier to lead to better outcomes.

Regardless, I believe it is a good thing that we are asking ourselves these questions. We question not to paralyze, but to be empathetic to those we serve, to be aware that we can always learn new and better approaches, and to be true to ourselves.

Charles Weinberg is the Local Recovery Coordinator for Huntington Veterans Affairs Mental Health Clinic in West Virginia. Contact him at Charles.Weinberg@va.gov.

Recovery Session Slated for National Meeting
RTP's June 29 session on multidisciplinary practice will culminate more than 8 months of planning, preparation, and the combined efforts of six behavioral health organizations to demonstrate how effective interdisciplinary treatment teams can be in the practice of recovery-oriented care.

The meeting's venue will allow RTP to have representation at a major conference—the widely attended National Alliance on Mental Illness National Convention. In a highly anticipated role-playing session, leaders of RTP's behavioral health fields (psychiatry, psychology, psychiatric nursing, social work, peer support, and addiction counseling) will portray team members developing a recovery plan with an individual who has been taken to the hospital after threatening suicide.

Workshop
Recovery-Oriented Practice Is a Multidisciplinary Practice

Date and Time
June 29, 10:15–11:30 a.m.

Location
Seneca Room, Seattle Sheraton Hotel, Washington

Healing Art
healing art When Alice, a graphic designer, began to compile images and writing that expressed her personal experience with depression, it was purely therapeutic. But she soon realized her collection could reach many individuals touched by the disorder, and created Black and White: Grey Matters as a safe space for people to view her gallery, contribute essays, and share secrets and dreams. Alice calls the site "a tool for people who struggle to find the words to describe what they are feeling." Her artwork is a graphic representation of the powerful emotions that epitomize long-term battles with fear, loss, and depression.

Women and Substance Abuse Treatment
In the past 30 years, substance abuse treatment has changed dramatically to address the gender-specific needs of women. As girls and young women develop, they are affected by socialization, stereotypes, and unique life events—factors that were traditionally disregarded in a field where services were designed by and for men. Eventually, policy makers called for the application of evidence-based practices, gender studies, and increased sensitivity to the issues and societal pressures women face.

The evolution of addiction therapy for girls and women has led some practitioners to question if mixed-gender treatment is effective—specifically, whether male therapists, counselors, and practitioners should provide counseling for women battling substance use. Risk factors, co-occurring conditions, and medical outcomes for men with histories of addiction may differ slightly or substantially in the female population.

Read the article.

RTP Wants to Hear From
Recovery-Oriented Practitioners!
We invite practitioners to submit personal stories that describe how they became involved in
recovery-oriented work and how it has changed the way they practice.
RTP Wants to Hear From You, Too!
We invite you to submit personal stories that describe recovery experiences. To submit stories or other recovery resources, please contact us at 877.584.8535,
or email recoverytopractice@dsgonline.com.

We welcome your views, comments, suggestions, and inquiries.
For more information on this topic or any other recovery topic,
please contact RTP at
877.584.8535, or email recoverytopractice@dsgonline.com.


The views, opinions, and content of this Weekly Highlight are those of the authors, and do not necessarily reflect
the views, opinions, or policies of SAMHSA or the U.S. Department of Health and Human Services.