Birmingham Health Mental

For hundreds of years, people diagnosed with mental illness were thought to be hopeless cases, destined to suffer inevitable deterioration. Beginning in the early 1990s, however, providers and policymakers in mental health systems came to promote recovery as their goal. But what does recovery truly mean? For example, to consumers of mental health services, it implies empowerment and greater resources dedicated to healing; to HMOs, it can suggest a means of cost savings when benefits cease upon recovery. This book considers "recovery" from multiple angles. Traditionally, Nora Jacobson notes, recovery was defined as symptom abatement or a return to a normal state of health, but as activists, mental health professionals, and policymakers sought to develop "recovery-oriented" systems, other meanings emerged. Jacobson's analysis describes the complexes of ideas that have defined recovery in various contexts over time. The first meaning, "recovery-as-evidence," involves the theories, statistics, therapies, legislation, and myriad other factors that constituted the first one hundred years of mental health services provision in the United States. "Recovery-as-experience" brought the voices of patients into the conversation, while "recovery-as-ideology" drew on both recovery-as-evidence and recovery-as-experience to rally support for specific approaches and service-delivery models. This in turn became the basis for "recovery-as-policy," which developed as assorted representative bodies, such as commissions and task forces, planned reforms of the mental health system. Finally, "recovery-as-politics" emerged as reformers confronted harsh economic realities and entrenched ideas about evidence,experience, and ideology. Throughout, Jacobson draws on her research in Wisconsin, a state with a long history of innovation in mental health services.

Doubts about the reality of mental illness and the benefits of psychiatric treatment helped foment a revolution in the law's attitude toward mental disorders over the last 25 years. Legal reformers pushed for laws to make it more difficult to hospitalize and treat people with mental illness, and easier to punish them when they committed criminal acts. Advocates of reform promised vast changes in how our society deals with the mentally ill; opponents warily predicted chaos and mass suffering. Now, with the tide of reform ebbing, Paul Appelbaum examines what these changes have wrought. The message emerging from his careful review is a surprising one: less has changed than almost anyone predicted. When the law gets in the way of commonsense beliefs about the need to treat serious mental illness, it is often put aside. Judges, lawyers, mental health professionals, family members, and the general public collaborate in fashioning an extra-legal process to accomplish what they think is fair for persons with mental illness. Appelbaum demonstrates this thesis in analyses of four of the most important reforms in mental health law over the past two decades: involuntary hospitalization, liability of professionals for violent acts committed by their patients, the right to refuse treatment, and the insanity defense. This timely and important work will inform and enlighten the debate about mental health law and its implications and consequences. The book will be essential for psychiatrists and other mental health professionals, lawyers, and all those concerned with our policies toward people with mental illness.