Philosophies and Principles
Developed and Defined by the CalMEND Client and Family Subcommittee
A major strength of CalMEND is the continuous inclusion of client and family member viewpoints and expertise in all that we do; in 2006, CalMEND decided to define a set of philosophies and principles based on this unique collection of experiences. This project was undertaken by the CalMEND Client and Family Subcommittee to further guide and inform our work as well as provide others with the invaluable tool of a client- and family-defined set of wellness and recovery values. Beginning with elements of SAMHSA's Consensus Statement on Mental Health Recovery, these elements grew through many discussions into a larger document, which was based--at its heart--on the accumulated understanding of the members of the CalMEND Client and Family Subcommittee and the experience and knowledge they have gained in disparate California communities.
Choice
It is essential that the mental health system provides a range of options in voluntary services so that together, the client, family and recovery team may explore different courses of action and make informed decisions regarding care and recovery goals. A client is not simply a subject who complies with directives from his/her provider, but rather, clients (and their identified family) and providers are partners in the healing process.
(SAMHSA, 2004)
Client & Family Involvement in System Development
As vital informants to system design and development, it is essential that client and family members participate on development and decision-making bodies within all levels of the mental health system, are educated about mental health funding and the implementation of laws, have impact on policy and quality improvement issues, and are recognized in their roles as experts by compensation for their time at a fair and competitive rate.
Client/Family-Driven
The recovery process is most successful when self-directed by the strengths and choices of the individual, who defines his or her own life goals and designs a unique path towards those goals. Client/family driven services exist when the beliefs, opinions and preferences of every client and their chosen family are a deciding determinant in service planning and an integral component of the recovery team.
Providing client/family-driven services goes beyond merely responding to clinical indicators; respecting the need for client/family choice allows an individual’s recovery to be directed by the expressed values and preferences of the client and their family. Consequently, the recovery team can best engage a client when willing to modify its understanding in the light of expressed dissent and seeks out, discovers, and utilizes consensus expertise to empower and engage clients with diverse cultural and ethnic identities and linguistic preferences.
(SAMHSA, 2004)
Community Partnerships and Collaboration
Community-level partnerships and collaborations support recovery by not only providing integrated services within the mental health system, but also through the coordinated inclusion of community resources and other services, such as supportive housing, employment, meaningful activity and social activities.
Accordingly, it is imperative that the mental health system direct outreach efforts to the broad array of diverse communities in which clients are a part (i.e. support groups, educational, religious and cultural centers, wellness centers, advocacy support, etc.) in order to promote understanding and responsiveness to the needs of clients and families on their recovery journeys, create awareness of stigma and discrimination, and further, work consistently to reduce it for persons with mental illness.
Dignity and Respect
Dignity and respect ensure that the recovery team engages the whole person, and is not just treating a “diagnosis”. Self-acceptance and regaining belief in one’s self are particularly vital for all clients - dignity and respect provide inclusion and the full participation of clients in all aspects of their lives, including welcoming communities and services.
(SAMHSA, 2004)
Easy Access
Providing easy access entails quality of care and choice being present from the first contact with a client. Mental Health services can be most effective when access to them is uncomplicated, straight-forward and painless. It is essential that individuals, families, providers and communities work together to facilitate access throughout the system so that a client experiences no wrong doors on his/her journey of recovery.
Effective
Effective services are evidence-based (or promising) and respectful of - in fact, provided in response to - individual choice and preference.
Empowerment
A client and his/her family of choice is empowered when their needs, wants, desires and aspirations are respected, valued and encouraged. It is imperative that clients have the authority to participate in all of the decisions that affect their lives—including the allocation of resources—as they are educated, supported and strengthened by doing so. Through empowerment, an individual can gain control of his or her own destiny and influence the organizational and societal structures in his or her life.
(SAMHSA, 2004)
Engagement
Engagement is the initiation and ongoing establishment of a positive, healing relationship between the provider and the client/family, and is characterized by the nurturing and enhancement of trust and respect among all parties. Engagement includes recognizing and attending to relevant cultural and ethnic values, practices and linguistic preferences. Engagement is a crucial step towards obtaining accurate information about the client and in helping formulate and carry out an individualized and effective treatment strategy.
Engagement and trust-building may take considerable time and consistent effort from providers as it is important to move at a pace that is comfortable to clients and families. Strategies that are patient, persistent and non-threatening are keys to engaging clients and families.
Equitable
It is vital that no stigma or discrimination is applied to clients and families and that access and quality of care do not vary because of client or family characteristics such as race, ethnicity, age, gender, religion, sexual orientation, disability, diagnosis, geographic location, socioeconomic or legal status.
(IOM, 2001)
Family-Friendly Care
Family-friendly care starts with the identification of a client’s family of choice (i.e. parents, grandparents, aunts, uncles, siblings, best friends, ministers, caregivers, next door neighbors, etc.) and is supported by ongoing attempts to engage and encourage healthy education, support and involvement in the recovery journey. For adults, the scope of shared personal information is client-directed to maintain an effective, healing partnership.
Goal-Oriented
It is essential that the recovery process is self-directed by the individual, who defines his or her own life goals and designs a unique path towards those goals. It is also important to keep in mind that progress towards achievement of goals can be slow and steady and that goals may change over time.
(SAMHSA, 2004)
Harmony
Harmony can be described as a state of spiritual, physical, communal and emotional balance for the individual, his/her family and community. This state of being can foster health, wellbeing, purpose and recovery. Although harmony is something developed by an individual, services and supports can promote or hinder the process.
Holistic
Recovery encompasses a holistic approach, involving an individual’s whole being, including mind, body, spirit, family, friends, and community. Accordingly, recovery may involve all aspects of life, including but not limited to housing, employment, education, mental health and healthcare treatment and services, complementary and naturalistic services, addictions treatment, spirituality, creativity, social networks, community participation and family supports as determined by the person.
(SAMHSA, 2004)
Hope
Hope is belief in an individual’s ability to get well and live a meaningful life. Hope is the foundation and catalyst of the recovery process, leading to a sense of strength, competence, and positive gain. Hope in a better future provides an essential and motivating message of recovery, that people can and do overcome the barriers and obstacles that confront them.
(SAMHSA, 2004)
Inclusion
At a system level, services and supports should welcome and respect individual cultural and ethnic identities and linguistic preferences. The recovery team imparts a sense of personal value in the client and conveys belief in his/her capacity to succeed.
Further, to support the inclusion of mental health clients throughout broad communities, ongoing efforts are made to reduce prejudice, eliminate stigma, and create greater understanding and acceptance of mental illness everywhere in the community.
Inter-Dependence
Interdependence is the dynamic of being mutually dependent upon and responsible to others. Like independence, inter-dependence is a cultural value that instills dignity and self worth in an individual by allowing him/her to fulfill a unique role in family, culture and/or community. It is essential that each client’s preference for interdependent participation with community, family and/or individuals is respected and incorporated throughout all services.
Linkage of Individuals to Community-Based Resources
Person-centered access requires collaboration between health and human service agencies and community-based and other resources in order to meet individuals’ and families’ needs at the point of contact, wherever they occur. Programs and initiatives are in place to reach out and engage individuals who may be in need of services but experience barriers to seeking help that may include cultural and language barriers, lack of knowledge, fear, embarrassment, distress, confusion, homelessness, illness, addiction, lack of transportation, lack of financial resources amongst other perceived and real barriers.
Meaningful Niche/Fulfilling Life
Finding a meaningful niche is the path to discovering one’s self, strengths and direction. The realization of one’s strengths can bring meaning and fulfillment to an individual's life by creating renewed hope, purpose, and the opportunity to search for his/her dreams, discover who he/she is and what makes him/her happy.
For many, leading a fulfilling life includes finding vocational or occupational interests/commitments, whether it is volunteer, transitional or paid. By making choices and empowering themselves, clients are able to find fulfillment and increased self-esteem.
Natural Supports
Natural supports are personal associations and relationships that are developed in the community and enhance the quality and security of one’s life. This includes family relationships, diverse friendships that reflect neighborhood and community, fellow students and/or employees, and affiliations developed in clubs, organizations or through other activities. Natural supports are critical to decreasing stigma and isolation as social inclusion increases wellness.
(Department of Developmental Services, www.DDS.gov )
Non-Linear
Recovery is not a step-by-step process but one based on continual growth, occasional setbacks and learned experience. Recovery begins with an initial stage of awareness in which a person recognizes that positive change is possible. This new found awareness enables the client to move on to fully engage in the work of recovery.
(SAMHSA, 2004)
Openness to Alternative Choices
Shared decision-making and person-centered approaches may require serious consideration, discussion, and openness to alternative choices, including cultural traditions, non-medical services and other client preferences or interests.
Peer Support
Peer Support is the sharing of experiential knowledge, skills and social learning and plays an invaluable role in recovery. Clients encourage and engage their peers in recovery by providing each other with strength, a sense of hope, belonging, supportive relationships, valued roles and a sense of community. These relationships may diminish feelings of isolation and provide a client or family member with the opportunity to meet, learn from, and become the authority on themselves and their experiences. Peer support may be beneficial to adult clients, family members and youth.
(SAMHSA, 2004)
Personal Community
Involvement of personal community may provide the individual with security, protection, and understanding when receiving or seeking services.
Personal Learning and Growth
In the recovery model, a client's role includes learning how to take charge of his/her own healing process. A client will develop this attribute through a range of sources and experiences as the individual faces situations in which he/she can learn more about his/her abilities to understand and grow. Any situation can be a learning opportunity if, through it, the client is able to develop coping skills and resilience.
Person-Centered
Person-centeredness is a comprehensive approach to understanding each individual and their family’s history, common needs, strengths, recovery, culture and spirituality. Using a person-centered approach means service plans and outcomes are built upon respect for the unique preferences, strengths and dignity of each whole person.
Recovery
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.
(SAMHSA, 2004)
Recovery Environment
A recovery environment is inviting, comfortable and safe, communicates hope, opportunity and wellness and provides non-threatening challenges and opportunities. The client, family and recovery team listen and communicate thoughts and ideas in an atmosphere where all can speak and be heard successfully. Such an environment allows a client and his/her family to develop trust in their supports and fosters confidence that his/her goals are worthy and attainable.
Resilience
It can be a normal part of recovery to have setbacks. Resiliency is the ability to withstand or quickly recover from difficult circumstances. By using selected supports, retaining knowledge, maintaining a positive attitude, and continuing his/her individualized recovery plan, a client will often be healthier than before the setback, with new self-knowledge.
Safe
It is essential that services are provided in an emotionally and physically safe, trusting and caring environment for clients, family members and the recovery team.
Self-Determination
Self determination is the faculty of an individual’s will and persistence to strive towards a chosen goal and accomplish it. In the recovery model, the trait of self-determination is crucial in overcoming obstacles and setbacks. No matter what the obstacles are, the recovery process allows the client to recognize that even small steps are a realistic accomplishment towards goals, and that setbacks can be an opportunity to learn and grow. A client needs to believe that anything he/she can do to succeed is an accomplishment.
Self-Direction
Self direction is the self-management of personal independence and as such, represents a client's development and increased use of natural supports like self care, housing and employment. These abilities, remembered or new-found, aid the client in realizing the optimal in their overall health and personal achievement. Clients lead, persist and exercise choice over their own paths of recovery by optimizing individual autonomy, independence and control of resources to develop strength and purpose in their lives.
(SAMHSA, 2004)
Self-Help
Self-help occurs when a client uses his/her time in a wise, productive manner using capabilities and desires found within, such as assertiveness or advocacy. The use of these strengths demonstrates that he/she is capable of succeeding and is crucial to finding quality of life and a meaningful niche.
Self-help may also refer to productive use of peer support. Through the recovery process, an individual may become a role model for other clients, sharing his/her experience, knowledge of recovery, and tools/strategies for coping.
Self-Management & Self-Responsibility
Clients have a personal responsibility for their own self-care and recovery process. Taking steps towards achievement of their goals may require great courage as clients strive to understand and give meaning to their experiences, learn coping strategies and identify healing processes that promote their own wellness.
(SAMHSA, 2004)
Shared Decision-Making
An interactive partnership is formed between a client, his/her selected family and the recovery team whereby the provider acts in the capacity of consultant to the client by providing information, discussing options, clarifying values and preferences and supporting the client’s autonomy. This process is used to make decisions regarding care options and recovery goals.
(Adams & Drake, 2006)
Socialization/Connectedness
The formation, expansion and use of safe and healthy relationships with family, friends and community can be a critical step in decreasing isolation and lack of socialization. It is important that services empower, educate, and promote the connection of self to others, the environment and community, and to meaning and purpose. In a healthy context, even passive, social connectedness and consequent informal role modeling can significantly aid recovery.
Spirituality
Spirituality represents a deep sense and experience of belonging and connection to a life philosophy, higher power and/or the sacred. Spirituality often provides an inner anchor that brings balance, peace, centeredness, and resilience in dealing with life events. Spirituality can support each person’s own personal recovery journey, and may be a tremendous source of strength, hope and energy. Providing client/family-driven services requires that an individual’s spiritual beliefs, preferences, traditions, and practices are respected.
Strengths-Based
Strengths-based is a primary, respectful approach that focuses on individual choice and preference and a person’s strengths, gifts and abilities to help them gain meaningful involvement in society. Every person has strengths that need to be recognized.
Timely
Timely engagement in services and/or supports is achieved through a shared decision-making process and is based on individual needs for responsiveness. Timely care may be anticipatory and respond to both immediate needs and long-term recovery goals. When needed, it is imperative that services are promptly and appropriately provided on an individualized basis in order to restore and sustain clients’ and families’ integration in the community.
Bibliography
US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services. National Consensus Statement on Mental Health Recovery. www.SAMHSA.gov, (2004)
Adams, J. and Drake, R. Shared Decision-Making and Evidence-Based Practice. Community Mental Health Journal, Vol. 42, No. 1, February 2006.
Committee on Quality of Health Care in America, Institute of Medicine
Crossing the Quality Chasm: A New Health System for the 21st Century, Washington, DC, USA: National Academies Press; 2001
