One of our proposed Four Freedoms of Mental Health
is the freedom to pursue recovery.
Recovery from mental disorders is a process that unfolds over time; the Substance Abuse and Mental Health Services Administration (SAMHSA) defines recovery as “a process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential” (Substance Abuse and Mental Health Services Administration, 2019). Living a self-directed life is a cornerstone of recovery—and a central focus of treatment at Riggs. Given the real obstacles posed by stigma, limited clinical models to help address mental illness for many individuals, and lack of access to medically necessary treatment—especially in the tendency of many insurance entities to limit access to care to crisis stabilization—the prospect of achieving recovery can be daunting.
One in five Americans (more than 46 million of us) live with a mental illness (National Institute of Mental Health, 2019); nearly all of us either struggle ourselves or know someone who does. While there are multiple paths and treatments that can lead toward recovery; each one of us experiences the complicated interactions of our biology, individual psychology, and our social environments in different ways, making each person’s journey toward recovery unique and individual.
It was the voice of those struggling with mental illness, with lived experience, along with longitudinal data demonstrating the reality of recovery for the mentally ill, that helped to launch the recovery movement in the late 1970s with its two core principles: “that people with mental illnesses can lead productive lives even while having symptoms, and that many will recover from their illnesses” (Davidson, 2016). This perspective helped shift the way mental illness was thought of—there was hope and a broad diversity of positive outcomes in long-term data and personal stories from all walks of life. This is not to suggest that stigma did not (and does not) persist, but rather to illustrate the bending of the arc toward a more just understanding of mental illness over time.
The inclusion of “mental impairments” in the definition of disability and the recognition of “psychiatric disabilities” in the Americans with Disabilities Act (ADA) passed in 1990 furthered the recovery movement by providing more safeguards for individuals with mental illness to pursue recovery without fear of discrimination by their employers (ADA National Network, 2018). The passage of the Affordable Care Act (ACA) in 2010 made it possible for more individuals to receive “recovery supports” that may not have been classified as “medically necessary” before (Davidson, 2016).
In the same way that relationships are central in our lives and must be tended to, worked at, and taken seriously, recovery from mental illness, too, must be worked at over time, pursued through therapy and/or use of medications, but also nurtured in other ways. Recovery is an active, intentional process, but no matter what it looks like for a given person, everyone struggling with mental illness deserves the chance to pursue recovery in a way that helps them to lead a fulfilling, self-directed life.
Too often insurance entities have limited authorization of treatment to the need for crisis stabilization, rather than pursuit of recovery. That is, when a crisis or acute symptoms subsides, insurance support for further treatment is often withdrawn. Pursuit of recovery frequently requires ongoing access to treatment to address underlying problems, the impact of early or recent trauma or adversity, the risk of recurrence, chronicity, or other factors beyond crisis and symptom stabilization alone. A recent landmark verdict in a Federal class-action lawsuit advanced the cause of recovery as the goal of treatment. In Wit v. UBH/Optum, Chief Magistrate Judge Spero’s verdict faulted UBH/Optum for substituting the goal of crisis intervention for the goal that is generally accepted by clinicians—the pursuit of recovery and of an opportunity to live a self-directed life that takes into account one's strengths and weaknesses. Judge Spero noted that UBH/Optum appeared to have allowed financial incentives to interfere with its contractual obligation to its insureds to provide medically necessary treatment (Psychiatric News, 2019).
At the Austen Riggs Center, we think about recovery as a fundamental right and a process by which our patients work with staff to identify a path toward living a self-directed life, a notion that is spelled out in one of our core values—patients have authority in their lives, including in their treatment. Claiming or reclaiming a self-directed life in the pursuit of recovery is a fundamental freedom that all who struggle with mental disorders should be afforded.
ADA National Network. (2018). Mental Health Conditions in the Workplace and the ADA
. Retrieved from ADA National Network: https://adata.org/factsheet/health
Davidson, L. (2016, June). The Recovery Movement: Implications For Mental Health Care And Enabling People To Participate Fully In Life. Health Affairs
, 35(6). doi:https://doi.org/10.1377/hlthaff.2016.0153
National Institute of Mental Health. (2019, June 4). Mental Illness
. Retrieved from National Institute of Mental Health: https://www.nimh.nih.gov/health/statistics/mental-illness.shtml
Psychiatric News. (2019, March 7). UBH Found to Have Wrongfully Denied Care Using Flawed Medical Necessity Criteria
. Retrieved from Psychiatric News
Substance Abuse and Mental Health Services Administration. (2019, May 17). Recovery and Recovery Support
. Retrieved from Substance Abuse and Mental Health Services Administration: https://www.samhsa.gov/find-help/recovery