This article offers one theoretical perspective of peer support and attempts to define the elements that, when reinforced through education and training, provide a new cultural context for healing and recovery. Persons labeled with psychiatric disability have become victims of social and cultural ostracism and consequently have developed a sense of self that reinforces the "patient" identity. Enabling members of peer support to understand the nature and impact of these cultural forces leads individuals and peer communities toward a capacity for personal, relational, and social change. It is our hope that consumers from all different types of programs (e.g. drop-in, social clubs, advocacy, support, outreach, respite), traditional providers, and policy makers will find this article helpful in stimulating dialogue about the role of peer programs in the development of a recovery based system.

The concept of recovery has emerged as a significant paradigm in the field of public mental health services. This paper outlines how the concept is being implemented in the policies and practices of mental health systems in the United States. After a brief overview of the historical background of recovery and a description of the common themes that have emerged across the range of its definitions, the paper describes the specific currently strategies used by the states to implement recovery principles. The authors conclude by raising key questions about the implications of adopting recovery as system policy. Conceptualizing Recovery Medical professionals have long recognized that people can recover from physical illnesses. Treatments for disease commonly take recovery-defined as return to the pre-morbid state-as their goal. Most people have had the experience of coming to terms with traumatic or stressful life events. In common parlance, this experience is also called recovery. As alcoholism and other addictions have been reconceptualized as diseases (rather than failings of character), the word recovery has been applied to the process of learning to live a full life without alcohol or drugs. The meaning of "recovery" has different nuances: restoration of normal health and functioning; a strength of character born of surviving tough times; the challenge of not allowing a serious or long-term condition to consume or dominate one's life. Conceptualizing recovery as

Structured shared decision making in mental health shows promise in supporting service user involvement in critical decision making and provides a process to open all treatment and service decisions to informed and respectful dialogue.

Given the rapid growth of this intervention in the U.S. and internationally, these results contribute to the evidence base for peer-led services, and suggest that more rigorous investigations are warranted in the future.

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Supported housing, preferred by consumers and demonstrated as effective for individuals with psychiatric disabilities, has taken four approaches: residential services, intensive case management, hybrid, and homeless outreach. Evaluating the choices for local settings requires confronting issues offlexibility and responsibility.