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Mr. del Vecchio is associate director for consumer affairs at the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville, Maryland 20857 (e-mail, firstname.lastname@example.org). The views expressed are the author's and do not necessarily represent those of the U.S. Department of Health and Human Services.
As a mental health consumer, family member, and professional, I agree with Davidson and colleagues' (1) analysis of recovery and barriers to its implementation, with two major exceptions.
First, contrary to the authors' assertion, a consensus is emerging on defining recovery. The Substance Abuse and Mental Health Services Administration recently released a National Consensus Statement on Mental Health Recovery (2) based on the deliberations of consumers, providers, families, advocates, researchers, and state and federal officials that offers a unifying definition: "Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential."
Recovery reflects faith that consumers can and do overcome the obstacles that confront us. It brings hope to people with mental illnesses and our families and provides the raison d'être for workers in the mental health field. The consensus statement stresses that consumers want a life that is healthy, free, and full. Or put another way, it reflects the most precious of American principles: the unalienable right to life, liberty, and the pursuit of happiness.
Second, although I agree with Davidson and colleagues that perceived risk is a concern, there is a greater underlying obstacle to achieving recovery, which the U.S. Surgeon General, the President's New Freedom Commission, and the Institute of Medicine clearly identify: hegemonic stigma and discrimination. In effect, stigma and discrimination and recovery are inexorably linked: no justice, no recovery.
We mental health professionals have unwittingly reinforced this devaluation of consumers. Historic practices of sterilization, psychosurgery, seclusion and restraint, and institutionalization have undoubtedly resulted in the public's impression that consumers are "less than" other humans. Provider training, with its primary focus on the deficits of consumers, may promote stigma and discrimination by too often neglecting the resiliencies, competencies, and capacities of those served.
Individuals with mental health problems and our families also have contributed to stigma and discrimination by being silent about our illnesses, by promoting coercive approaches (in the case of some families), and by not effectively organizing politically to alter public attitudes and policies.
What will it take to finally overcome stigma and discrimination? I offer three recommendations to help us fully achieve the promise of recovery.
• Conduct public education on the capacities of people with mental health problems to overcome their illnesses and participate fully in their communities. The media and policy makers, in particular, should be targeted for this compelling message.
• Come out of the closet. Interpersonal contact with a person who has a mental illness is a proven strategy for overcoming stigma and discrimination (3). Yet, for contact to work, people must self-disclose. Such disclosure can be risky, but encouraging more citizens to self-identify will ultimately defeat the "us versus them" mentality.
• Create and adopt a new professional paradigm—the recovery model—to effect a cultural change in how we serve people with mental illnesses. We all must become "recovery champions." The American Psychiatric Association's recent position statement on recovery is promising in its endorsement of consumers' participation in their care and its focus on hope (4).
The wonder is that despite stigma and discrimination and other barriers, recovery happens—which highlights the capacity of people with mental illnesses to overcome often incredible odds. We can make it easier by eliminating stigma and discrimination.
People with mental illnesses are indeed people first—entitled to the same rights, responsibilities, and opportunities afforded to all. Recognizing and celebrating this shared humanity should be our foremost priority.
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