"An Old Way to Solve an Old Problem": Provider Perspectives on Recovery-Oriented Services and Consumer Capabilities in New Mexico

Abstract

The goal of recovery has emerged as a core value in the reformation of public and private mental health services in the last twenty years. However, definitions of recovery remain as varied as methods of implementation. Through an ethnographic lens, we examine meanings of recovery in the context of a major statewide reform of mental health services in New Mexico, focusing specifically on provider-voiced concerns regarding recovery and recovery-oriented care. We argue that the concept of recovery functions as a symbol that seemingly reconciles the long-standing tension between biological and social explanations of mental illness. Drawing upon provider perspectives, we also discuss concerns that popular rhetoric about recovery may mask some needed fundamental changes to transform the mental health system to a recovery orientation. Finally, we consider recovery from a capabilities standpoint and discuss how this view lends itself to addressing both individual and social components of mental illness.

The Transformation of Behavioral Healthcare in New Mexico

“…Key findings from this work (Table 1) replicate those reported in our earlier analyses of reform (Semansky et al 2012; Waitzkin et al 2002; Watson et al, 2011; Willging et al 2013). Collectively, our studies illustrate that top-down planning shaped by outer context considerations, insufficient concern for ensuring innovation fit, minimal preparation at the system and organizational levels, and inadequate delineation of key expectations and implementation processes, create challenges for service agencies and providers.…”

“…This emphasis on recovery had already taken root in other states (Jacobson 2004), and clients and advocates embraced it in NM (Watson et al 2011). The “recovery” concept, as set out by the President's New Freedom Commission on Mental Health (2003, p. 5) and as defined in NM state policy, referred to “the process in which people are able to live, work, learn, and participate fully in their communities,” and “the ability to live a fulfilling and productive life despite a disability.” In dominant recovery discourse, frontline service providers were to “assist” rather than “direct” their clinical encounters, by building “partnerships”, helping them come to terms with their illnesses, and to take responsibility for managing their life choices, including those regarding services (Jacobson 2004; Watson et al 2011).…”

Living with a Thousand Cuts: Self‐Cutting, Agency, and Mental Illness among Adolescents

“…From the standpoint of CPH clinicians, this meant that patients were often being discharged to disorganized family environments which did not provide sufficient opportunity for their condition to stabilize or to less intensive levels of care for which they were not prepared (see also Kano, Willging, and Rylko‐Bauer ; Watson et al. ; Willging, Waitzkin, and Lamphere ; Willging and Semansky ). Yet whether the experience leans toward the carceral or the caring depends not only on the character of the institution but on the different pathways into the hospital including through the police, the courts, physicians, families, and in some instances, volunteering.…”

Straining Psychic and Social Sinew: Trauma among Adolescent Psychiatric Patients in New Mexico

“…From a statewide New Mexico perspective, an ethnographic study of mental health professionals (Kano et al ; Watson et al ; Willging and Semansky ; Willgin et al ) examines the pragmatic, institutional, and policy effects of behavioral health care reforms underway during the course of our research. These findings are fully in accord with our observations and interaction with staff at CPH.…”