by Nora Jacobson; Nashville, Tennessee, Vanderbilt University Press, 2004, 208 pages, $24.95 softcover
Dr. Blyler is a social science analyst with the Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, Rockville, Maryland.
Nora Jacobson opens her book by describing the creation of the Commission on Mental Health. "With his signature on an executive order … (he) established the … Commission on Mental Health, a body to be made up of 'representatives from government, the mental health professions, the public and private sector and individuals who have an interest in the future direction of mental health care.' … Citing a need to 'closely examine the present mental health care delivery system and how said system should evolve into the twenty-first century,' … the Commission was to undertake a review of the … treatment and support services, its organizational arrangements, and its financing mechanisms, and, within a year, make recommendations that would restructure them into a coordinated system with an emphasis on prevention, stigma reduction, consumer outcomes, treatment effectiveness, efficiency, and accountability."
Dr. Jacobsen then adds the focus of the commission. "The philosophical cornerstone of the commission's recommendations was the adoption of 'the concept of recovery, that is, the successful integration of a mental disorder into a consumer's life, as the key tenet of the redesigned mental health system.'"
My initial reaction in reading the opening chapter of In Recovery was a sense of deflation. For the past year, I have been working with the Substance Abuse and Mental Health Services Administration's Center for Mental Health Services to transform the nation's mental health systems in keeping with the goals laid out in the 2003 final report of the President's New Freedom Commission on Mental Health (1). Although the goals of the report are noble and worthy of aggressive pursuit, I have come to understand that transformation is supposed to create something new, both within the states and across the nation. The above quotes, however, refer not to the President's Commission but to a Blue Ribbon Commission on Mental Health convened by former Governor Tommy Thompson in Wisconsin in 1996, thereby revealing that everything old is new again.
People who are familiar with the nation's current transformation efforts will immediately recognize the similarities between the instructions and goals of Wisconsin's redesign efforts and those of the President's Commission. How much, one might ask, was the outcome of the New Freedom Commission, which was convened and completed when Tommy Thompson was serving as the Secretary of the Department of Health and Human Services, predetermined by the way events unfolded in Wisconsin under his leadership? This question serves as an initial hook for In Recovery, and the wealth of substantive information and kaleidoscopic perspectives contained in subsequent chapters generates increasing excitement as the history unfolds.
As a post-doctoral fellow in the University of Wisconsin's Mental Health Services Research Training Program, Dr. Jacobsen's sociological study focuses on the definition and implications of recovery-oriented mental health systems. As a result of her systematic observations, she has written a textbook that reads like a novel and provides an in-depth understanding of the history of recovery concepts, along with detailed descriptions of how such concepts can be implemented meaningfully across mental health systems. In Recovery is a must-read for all students of and participants in the transformation of mental health systems in the 21st century.
Achieving the Promise: Transforming Mental Health Care in America. Pub no SMA-03-3832. Rockville, Md, Department of Health and Human Services, President's New Freedom Commission on Mental Health, 2003