Recovery: A Useful Resource in the Managed Care Era

Peter Murray, MD

Community Psychiatrist

So how are you doing with managed care? Where I work, pressure to reduce costs is bringing rapid changes to inpatient programs: nursing staff is being slashed, relatively unskilled workers are being brought in to mind the patients, and sometimes it seems as though everything not bolted down or labeled as Moving Toward Discharge is being tossed into the garbage. Everyone is scrambling to create new or bolstered outpatient programs to try to cover those needs that used to be obtainable only through hospitalization. At the same time, there is an ever-increasing fervor to reduce recidivism and cut the number of inpatient admissions. These are tough demands; all of us would like to provide cost-effective, quality-controlled resources that are attractive to patients. We would like to know of ways to foster patients that refuse to make use of outpatient resources but come into the hospital at crisis point several times a year.

Coming up with new programs, however, is time consuming and expensive. Moreover, effectiveness can't be guaranteed. And simply coming up with more outpatient programs doesn't solve the problems of many patients' under-utilizing everything but the hospital.

Let me suggest here that one resource, at least, is already in place which might help us meet several of the above needs. Many of you probably know about it, but may not be making much use of it. What I'm referring to is Recovery International, a self-help mental health organization with some 5000 people attending its weekly meetings in 700 locations in the US and abroad. Existing since 1937, when it was founded by neuropsychiatrist Abraham A. Low in Chicago, the Recovery Method is a systematized method of peer- and self-therapy based on techniques not unlike the more recent Cognitive Therapy; techniques which help patients to prevent relapse and reduce chronic suffering from mental illness.

Recovery intentionally avoids making therapeutic distinctions based on diagnoses in its groups, and instead focuses on helping members learn to cope more effectively with the "restlessness, tenseness, preoccupation, terrifying sensations, threatening impulses, obsessing thoughts and depressing feelings" that are actually common across many diagnostic groups. Even for those whose cognitive impairment makes full involvement in the method difficult, there may still be some benefit from support in a peer community. In addition, friends' and families' needs for their own support resources are now being served through The Relatives Project. This project, developed by the Abraham A. Low Institute, is creating self-help programs aimed at training family and friends of mental patients to "manage their own stress, create a domestic environment conductive to good mental health, and better understand the forces at work in that environment."

What are some of the potential advantages of referring patients to Recovery International? To begin with, the groups are already up and running and were developed as adjuncts to professional mental health resources -- not as their replacement. Also, Recovery meetings are extremely inexpensive ("free will" offerings are typically two or three dollars per meeting, but not required for participation); quality controlled (group leaders are required to participate in ongoing training and peer review -- by design, variation is minimal between meetings worldwide); and effective (references are available from Recovery International).

One other thing which is difficult to promote in the context of professional, hierarchical therapy is patients' responsible "ownership" of their mental health and illness. As a peer-based therapy, Recovery groups might offer some advantage in this area. It is conceivable that some patients' participation in Recovery might eventually even foster their being more compliant with professional outpatients resources.

Since Recovery International is a non-profit, peer-based organization, the groups have relied mostly on word of mouth between patients and their families to keep themselves going over the years. One problem with this, however, is that physicians, psychologists, social workers, and other referring clinicians have been largely "left out of the loop." We can afford this no longer. Recovery International has the potential to meet a lot of our patients' needs, and now -- more than ever -- is a good time to get involved in facilitating appropriate referrals. Recovery members are available to present demonstration panels in your hospital to promote smoother transitions to the community. If you want to see how a meeting runs, professional are welcome to attend (but not participate), as is the general public. There is also a video called Hidden Lives: Staying in Controlwhich provides a delightful glimpse of what Recovery International membership is about.

Posted with permission of Community Psychiatrist.

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