In Recovery: The Making of Mental Health Policy

For hundreds of years, people diagnosed with mental illness were thought to be hopeless cases, destined to suffer inevitable deterioration. Beginning in the early 1990s, however, providers and policymakers in mental health systems came to promote recovery as their goal. But what does recovery truly mean? For example, to consumers of mental health services, it implies empowerment and greater resources dedicated to healing; to HMOs, it can suggest a means of cost savings when benefits cease upon recovery. This book considers "recovery" from multiple angles.

Traditionally, Nora Jacobson notes, recovery was defined as symptom abatement or a return to a normal state of health, but as activists, mental health professionals, and policymakers sought to develop "recovery-oriented" systems, other meanings emerged. Jacobson's analysis describes the complexes of ideas that have defined recovery in various contexts over time. The first meaning, "recovery-as-evidence," involves the theories, statistics, therapies, legislation, and myriad other factors that constituted the first one hundred years of mental health services provision in the United States. "Recovery-as-experience" brought the voices of patients into the conversation, while "recovery-as-ideology" drew on both recovery-as-evidence and recovery-as-experience to rally support for specific approaches and service-delivery models. This in turn became the basis for "recovery-as-policy," which developed as assorted representative bodies, such as commissions and task forces, planned reforms of the mental health system. Finally, "recovery-as-politics" emerged as reformers confronted harsh economic realities and entrenched ideas about evidence, experience, and ideology.

Throughout, Jacobson draws on her research in Wisconsin, a state with a long history of innovation in mental health services. Her study there included several years of fieldwork and interviews with the government-appointed groups charged with making recovery policy. Thus, In Recovery also provides an inside account of the process of policy development and implementation.