Synopsis of Changes

             The organizational structure of mental health services has changed over the last few decades by shifting from institutional treatment to community-based treatment that focuses on a recovery-oriented approach (Gehart, 2012; Kaplan, Salzer, & Brusilovskiy, 2012; Onken, Craig, Ridgway, Ralph, & Cook, 2007; Pilgrim, 2009). These changes within the organizational structure of mental health services have made it possible for more individuals with a neurobiological disorder to live in communities. The United States government passed legislation which halted large group health plans (51 or more employees) from imposing annual or lifetime dollar limits on mental health benefits, because discriminating health insurance practices placed limits on insurance coverage for mental health and addictions treatment (SAMSHA, 2013). This was known as the Mental Health Parity Act (MHPA) of 1996. Yet, many consumers continued to receive inadequate services and treatment, and most communities continued to have inadequate resources (Corrigan, 2004; Komiya, Good, & Sherrod, 2000; Vogel, Wade, & Haake, 2006).  

            Consumer is a term that is preferred to be used; rather than, ‘client’, ‘patient’, or ‘service recipient’ (Gehart, 2012, Part I, p.431; President’s New Freedom Commission on Mental Health, 2003, p.4). This term is not meant to be derogatory or demeaning to people who are dealing with mental health challenges. In fact, the consumerism movement is the joining together of any individual who has had or is experiencing emotional and mental health challenges in a movement to regain their rights; thereby, “ridding society of discrimination and prejudice” (Holter, Mowbray, Bellamy, MacFarlane, & Dukarski, 2004, p.51).

The U.S. Supreme Court heard the case Olmstead v. L.C. (1999), and the justices determined that the Americans with Disabilities Act of 1990 requires states to place individuals with a neurobiological disorder in community settings when it is determined that community placement is appropriate; for that reason, the Olmstead v. L.C. case is used as the basis for making determinations about placement of individuals with a neurobiological disorder. As a result of the Olmstead v. L.C. case and the Consumerism movement, the New Freedom Commission on Mental Health (2003) recommended a policy shift that would transform mental health services and supports towards a ‘recovery-oriented approach.’ The idea of this type of transformation was a move in the right direction. According to Gehart (2012), “this approach draws upon some of the field’s best practices to create an approach that harmonizes with and supports the principles and ethics identified in the consumer-based, mental health recovery movement” (Part II, p.443). But, recovery is a broad term and without a clear definition and understanding of the term there were many misunderstandings surrounding its use by professionals and consumers. Since the policy that was developed lacked a clear definition Pilgrim (2009) pointed out that there was “little consensus on what recovery means in relation to mental illness” (p.477).  In order for there to be more of a consensus between professionals and consumers there needed to be a better description of what recovery meant and how recovery could be attained.

            In 2005, the Substance Abuse and Mental Health Services Administration (SAMSHA) came out with a definition of recovery, and they defined recovery as “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.” Despite this definition of recovery there was still confusion surrounding the definition of recovery. Davidson and Roe (2007) tried to decrease the confusion that surrounded recovery by dividing recovery into two categories: ‘recovery from’ which involves an individual with a neurobiological disorder diagnosis becoming symptom free and not being admitted into a hospital or facility as a patient, and ‘recovery in’ which is when an individual with a neurobiological disorder endures their fluctuating symptoms as they change.

            SAMSHA was central to the transformation of the recovery system when they made the commitment that, “The Concept of recovery lies at the core of SAMSHA’s mission, and fostering the development of recovery-oriented systems of care (ROSC) is a SAMSHA priority” (Center for Substance Abuse Treatment, 2006, p.8). During this time period some other issues arose: sixty percent of consumers were leaving mental health and substance use disorders treatment before completion of their treatment (Substance Abuse and Mental Health Services Administration Office of Applied Studies Treatment Episode Data Set 2005, 2008); organizations were finding it difficult to measure the results of recovery and the government started feeling the pressure to reduce spending. As a result, the government started holding organizational programs, and professionals, accountable to provide measurable results.

It was apparent that the entire mental health system needed to be changed, so in 2009 SAMSHA started releasing recovery-oriented publications to provide direction in making efficient use of resources (Sheedy & Whitter, 2009; Gaumond & Whitter, 2009; Halvorson & Whitter, 2009; Laudet, 2009). Furthermore, SAMSHA created best practices and common terms that could be incorporated into the mental health and addictions field (Sheedy & Whitter, 2009; Gaumond & Whitter, 2009; Halvorson & Whitter, 2009; Laudet, 2009). The United States government realized that there were millions of Americans with neurobiological and/or substance disorders that were not receiving the same level of care as Americans with other general medical conditions; as a result, the U.S. passed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 (Humphreys & McLellan, 2010). Then, SAMSHA (2010) released a three phase plan entitled Access To Recovery (ATR) Implementation Toolkit which was intended to help organizations receiving ATR grants to understand how to plan and implement recovery-oriented changes within their organization.

The MHPAEA's legislation was helping some Americans, but it was leaving millions of Americans without the needed medical insurance to get mental health services. Consequently, the U.S passed the Affordable Care Act (ACA) of 2010 (SAMSHA, 2013). However, there are challenges when implementing organizational changes. For example, some studies point to funding, administrative, and infrastructure challenges when implementing organizational changes (Halvorson & Whitter, 2009, p. 21). Halvorson & Whitter (2009) point out that “it’s important for all parties to be flexible during the alterations of the current mental health system;” however, the changes would continue over the next few years with the biggest changes being implemented in 2012 when the recovery process was transformed (p.17).