Recovery-Oriented Systems of Care: A Perspective on the Past, Present, and Future

Abstract

This paper provides a perspective on the recent concept of recovery-oriented systems of care with respect to its origins in the past and its status in the present, prior to considering directions in which such systems might move in the future. Although influential in practice, this concept has yet to be evaluated empirically and has not been the object of a review. Recovery-oriented systems of care emerged from the efforts of persons with mental health and/or substance use disorders who advocated for services to go beyond the reduction of symptoms and substance use to promote a life in the community. Subsequent efforts were made to delineate the nature and principles of such services and those required of a system of such care. Coincident with the U.S. Substance Abuse and Mental Health Services Administration dropping reference to behavioral health in its revised definition of recovery, confusions and limitations began to emerge. Recovery appeared to refer more to a process of self-actualization for which an individual is responsible than to a process of healing from the effects of a behavioral health condition and associated stigma. In response, some systems are aiming to address social determinants of behavioral health conditions that transcend the scope of the individual and to develop a citizenship-oriented approach to promote community inclusion.

Keywords: alcohol; behavioral health; mental health recovery; recovering citizenship; recovery-oriented care; recovery-oriented system of care; substance use recovery.

Figure 1. Recovery-oriented system of care

An integrated mental health and substance use authority provides care throughout the stages of recovery, beginning with public education, prevention, and mental health promotion. For those who do not seek care on their own, assertive outreach and engagement efforts provide outreach to people in distress or need, wherever they are. Active treatment and rehabilitation are supported with recovery support services, which helps to increase service engagement and effectiveness. Ongoing monitoring and early reintervention are provided as needed. State agencies and community collaborators act as partners to support the efforts of the integrated behavioral health authority.