Recovery-Oriented Psychiatric Services
by Christopher Camilleri, M.D.
Recovery to Practice Highlights November 29, 2012
By presenting a clear message of hope, psychiatrists and other behavioral health professionals can help facilitate a client's recovery. Our belief in the client as a whole person-not a set of symptoms-communicates confidence in his or her strengths, goals, and recovery potential. "I believe in you" and "I'm confident you can recover" are optimistic messages that help clients believe in themselves and increase their trust in the therapeutic relationship.
This message of hope should be delivered with the understanding that recovery often requires clients to change their thinking and behavior patterns, and that we will support them in this transition. It takes time to see improvement, but substantial progress can be made with effort, continued support, and conviction that recovery is possible.
Various strategies can awaken and sustain hope in clients. One technique involves collaboratively reviewing how they have improved, and helping them recognize how their strengths have contributed to positive changes. We can also share anonymous recovery stories and introduce clients to peers who are willing to tell their personal success stories. A client's spiritual and religious beliefs can be sparked or revived to inspire hope. And when they are relevant, timely, and appropriate, we can tell our own stories.
The story of "J," a 34-year-old man, epitomizes and inspires hope on every level. I had seen J at two psychiatric appointments. When I asked about his goals, he seemed unsure. He said he had worked before his "breakdown" but was told by professionals and others he would never be able to work again. Since J had not worked in more than 10 years, I explained it might take some time before he would be able to hold a job again, but that it was possible and we could work together to fulfill his goal. J also believed it was possible and said he was willing to try.
J pursued occupational therapy to help prepare for and find work. Over time, we discussed how to adjust his medication to minimize side effects and symptoms and improve his work performance. We also talked about strategies J could use to accomplish work assignments and interact with coworkers, even when he was experiencing symptoms. Together we found he worked better at his job on a lower dose of antipsychotics that reduced side effects. Although the new dosage increased the voices J heard, his goal of getting back to work was more important than eliminating his symptoms. He found a part-time job and began exploring job training opportunities. Being employed and seeing so many promising training options did more for J's recovery, hope, and outlook than he thought possible.
Honoring Client Choice and Judicious Medication Use
When it comes to medication decisions, prescribers must provide sufficient information to their clients. A client should also know about practical alternatives, including ways to overcome symptoms without medicine and strategies for functioning well with or without symptoms. If clients choose to take medication, the potential benefits, adverse effects, and therapeutic limitations should be clearly explained.
Some clients benefit from taking medication daily over an extended period, while others benefit from a short-term course. Some prefer to take medicine on an intermittent basis, and some prefer alternative approaches. Honoring choice and self-determination means we will provide education about our recommendations and collaborate with clients to develop an overall recovery and medication plan.
Alternative approaches include ongoing discussions to help clients improve their ability to manage and reduce symptoms and stressors. These discussions should break down social, psychological, medical, spiritual, and culturally specific strategies. Psychiatrists also have an opportunity to help clients change unhealthy thought and behavior patterns and begin replacing them with better choices. Thus, we can provide a beginning, continuation, and reinforcement of recovery support in conjunction with ongoing professional services and community resources like peer support.
Individualizing Psychiatric Services and Supporting Therapeutic Relationships
Psychiatric appointments are often called "medication services," "medication appointments," or variations on this theme. These appointments, which last about 15 to 20 minutes, focus on symptoms, medication side effects, and sometimes paperwork. Unfortunately, 20 minutes is not always enough time to understand a client's psychosocial issues and stressors, medical concerns, substance abuse problems, or other factors that may affect their symptoms. Because of time limitations, medication and medical issues often take priority over psychosocial factors, which can be just as important in addressing a client’s immediate needs and long-term recovery.
One way to provide optimal psychiatric services is to keep the frequency and length of appointments somewhat flexible. Appointments could vary from 15 to 45 minutes, from once every 3 months to two or more times per month, depending on the complexity and urgency of issues.
Seeing a client without prescribing medicine is a viable option for quality psychiatric services. When a psychiatrist discontinues a client's psychotropic medication, various institutional pressures discourage him or her from continuing to see the client. But the positive relationship between psychiatrists and clients can be an important aspect of recovery, and prematurely terminating this relationship could cause setbacks.
Psychiatrists can provide much more than prescriptions to promote a client's recovery. We can work with clients to develop hope and motivation and to make important changes for overcoming symptoms and achieving goals. We can create healing relationships and provide services to help clients become more engaged in community and family life. People benefit most when behavioral health professionals humanize their clinical role by combining sincerity, hope, and confidence in clients' ability to choose and achieve personal recovery goals.
Contact Dr. Camilleri at firstname.lastname@example.org.