An episode of Changing the Conversation podcast.
Mark Salzer shares insights on defining and measuring recovery and promoting meaningful community inclusion with host Livia Davis. This episode is part of a series where we share the wisdom amassed by recovery leaders over the past 5 decades and reflect on the journeys that have laid groundwork for today’s recovery movement.
January 5, 2026
[Music]
Livia Davis, Host (00:05): Hello, and welcome to Changing the Conversation. I’m your host, Livia Davis, the Chief Learning Officer at C4 Innovations. Today’s conversation is part of a podcast series called Learning From our Recovery Elders to Inform our Work as Recovery Leaders, where we delve into the profound wisdom amassed by recovery leaders over the past five decades. Through conversations, reflective storytelling, we illuminate the journeys of those who have laid the groundwork for today’s recovery movement. Our aim is to not only preserve their invaluable insights, but also to inspire future leaders in the ongoing pursuit of recovery. By sharing some of the history and lessons of recovery leaders, we also hope to inform the path forward for the next 50 years.
(00:57):
My guest today is Mark Salzer, calling in from Pennsylvania. Mark is a psychologist and professor of social and behavioral sciences. He’s also the director of the Temple University Collaborative on Community Inclusion of Individuals with Psychiatric Disabilities. Hello, Mark. Thanks for joining us today.
Mark Salzer, Guest (01:19): Hi, Livia. Thank you for having me.
Livia (01:21): You’ve been working in the field of recovery research for many years now. Can you tell us how you got into doing this work?
Mark (01:31): First of all, sometimes I’ll tell people that I was maybe genetically destined to work in the mental health area in general. My grandfather was a psychiatrist in the early days of psychiatry, and is co-credited with coining the term antidepressant. My mother worked as a psychiatric nurse on an inpatient unit that I worked on I think 25 years later in Minneapolis, Minnesota. I have a brother who is also a psychologist, so there’s something going on in my family. Good thing, bad, I don’t know what it is, but I’ve had a long-term interest in the mental health area in general, certainly friends and colleagues who experienced mental health issues.
(02:19):
I became interested in the recovery concept. I also refer to myself as a recovery baby, in that my career started around the time that recovery started to be talked about in the mental health, psychiatry literature, and it had a profound impact on me. I had been around to hear people with certain diagnoses, gloomy prognoses and these kinds of things, and the concept of recovery was really an epiphany. At the same time, I was also in graduate school, my very first year of graduate school, where I was learning about brain disorders and diagnoses and enlarged ventricles and psychotherapy treatment and medications and these kinds of things.
(03:16):
I was also fortunate to work with a self-help mutual aid group that started in Australia, and here during the daytime, I tell people in my classes, I was learning about people with mental health issues as kind of other, as people with deficits and impairments. In fact, one of my faculty referred to people as being “incapable of helping one another because they can’t even help themselves.” I was able to attend and observe self-help mutual aid group meetings and see people who had very significant issues in their lives who were providing the most amazing help to one another, and I think that’s really where. Around that same time, the term recovery was being used, and it was very energizing. It was definitely an exciting moment for me.
Livia (04:11): Thank you so much. I don’t think I’ve ever heard the term recovery baby before, but it makes some sense, giving the context and when you got into the field and some of the work ahead. You’ve been writing a lot about the history of recovery and you have some reflections about how the concept of recovery has come to be understood as it has evolved. Can you talk about your historical knowledge and reflections?
Mark (04:43): Yes. I’ve been fortunate to work with somebody named Pat Corrigan for a number of years. He’s just a wonderful person, brilliant scholar. He does a lot of work in the stigma area but also worked in the early days in the recovery area, especially to come up with a measure of recovery. There’s actually been a lot of effort to try to measure what recovery is all about, so much so I’ve identified at least 20 different measures of recovery, which I think is one of the challenges that we have in the field. I was involved with Pat, with the development and further understanding of one of these particular measures, called the Recovery Assessment Scale. I do think it’s a good measure of recovery, but again, it’s one of 20-plus measures that’s out there.
(05:41):
I’ve been doing that work for about 20 or 25 years using this measure, understanding this measure, using it as an outcome tool in different studies. Over this time period, I’ve become increasingly concerned about, first of all, what is this term recovery? What does it mean? How do we measure it? How do we understand it? What are the implications of this concept for mental health policies, systems, services, and those kinds of things? You mentioned an article that I wrote most recently where I’ve had these concerns for many years, but I also think recovery has had a tremendous impact on mental health policies and systems as well.
(06:37):
I don’t want to criticize or I don’t criticize recovery, the concept. I think it is real. I have many friends and colleagues who live recovery, and it’s had a tremendous impact on especially the development on hope that people with significant mental health issues can live good lives, but I’ve also been really frustrated, along with other colleagues, about the many definitions of recovery, the many different measures, the many different conceptual frameworks and models for recovery.
(07:20):
Some colleagues have been very critical of the concept and how it’s been applied. One of my favorite expressions was a title that Larry Davidson and colleagues used for one of their articles where they expressed concerns about recovery programs as systems potentially being “old wine in new bottles”, that people just started doing, kept doing the same things, but they called it recovery now, or they said it was recovery-oriented. The concern is that it’s been utilized in a very superficial way.
(08:01):
The most significant concern that I’ve heard out there is from a group. I don’t even know who’s behind this group, but it’s in the UK and they’re called Recovery in the Bin. They express concerns about recovery, so significant are the concerns that they think we should possibly discard the term. The concern that they express is that the concept of recovery has become so vague and poorly utilized that it keeps us from looking at the most significant things that impact people’s lives, like poverty, prejudice, discrimination, lack of access to resources. These are the things that really impact people’s lives. If we’re talking about hope and these kinds of things, it distracts us from these other things.
Livia (08:56): I heard this term once and I’m not sure who said it, but I like it a lot, especially when you’re talking about different conversations and different opinions, that “it’s the dance that matters”, right? It’s the importance about being able to talk about different viewpoints and sharing different beliefs, sharing different opinions, sharing concerns from all sides is as important as anything else to advance a field. I think it’s very important to also air concerns because that’s also how we evolve, right? It’s the dance that matters also in terms of how we have conversations about this. Do you have any thoughts about the concept as it’s evolving into the future? How are you thinking about the concept of recovery?
Mark (09:54): As I was writing this article recently and coming to the realization, again, there are 20-plus measures, there are numerous different definitions, there are different frameworks and principles and different ways for understanding recovery, at the same time I reread Pat Deegan’s article from 1988, and this is the first article that I have come across that uses the word recovery, and Pat is one of the most brilliant people I think we have in our field.
(10:30):
One of the things that Pat wrote that I had forgotten about is that she wrote that recovery is real. Again, I believe it. I have seen it. I think it has had important impacts on the field, but she also said that it might be such a complicated concept that we might not be able to define it in typical, traditional scholarly or academic ways. I have come to believe that, and believe that it’s really an incredibly hard concept to really define and describe. What that also means is that it makes it hard to apply the concept. How would this influence policies and systems and programs and practices?
(11:19):
At the same time that I have written this article, I also have been working in an area of community integration and community inclusion. These are concepts that have been around in the broader disability community, people with physical, sensory, intellectual and developmental disabilities, for about 70 years or so, so really longstanding. These other disability communities don’t talk about things like recovery. They talk about rights first of all, and Pat Deegan was all about rights and is all about rights.
(12:00):
This broader disability community talks about this concept of integration and inclusion as the right to live in the community like everybody else, to work, to go to school, dating, parenting, leisure, recreation, voting, volunteering, going to church, synagogue, mosque, friendships, family relationships, intimate relationships, and that people who experience disabilities, including people with significant mental health issues, have the right to that opportunity to live in the community like everybody else. These are the concepts I think we need to bring into the mental health field, and that my colleagues and I have been fortunate to try to bring into the mental health field for a little more than 20 years now to really advance recovery.
(12:51):
The implications, I think, are much more direct than talking about this term recovery. It means that we must be talking to people with mental health issues about things that are meaningful to them. Work, going to school, dating, parenting, all of these areas, what is meaningful to you? We should be encouraging and supporting people in pursuing these activities, and we should be assessing whether or not people are doing the things that they want to do.
(13:29):
We also know that the resulting participation, we know that work and going to school and leisure and recreation and spending time with friends and family, dating, volunteering, being involved in a faith community, if these are important to you and you’re participating in them, there’s good research suggesting that this is associated with positive health outcomes, physical health outcomes in that it gets you up, off the couch, out of bed, out in the community and moving, it’s good for cognitive health and good for brain health and memory and executive functioning, and it’s good for mental health and wellness, including recovery.
(14:13):
We have research indicating that people with significant mental health issues who are participating more in ways that they want to participate score higher on these recovery measures. We believe that it’s associated with greater sense of belonging, greater sense of mattering, “I am important.” It changes one’s identity. Instead of an identity as a patient, it’s an identity as a worker, as a student, as a partner, as a volunteer. Then we also have research suggesting that people who participate more have less depression and feel less lonely. They feel more connected to the community. This is really one direction for advancing recovery that my colleagues and I have been pursuing.
Livia (15:07): There’s so much in what you said. Thank you, Mark. I think, if I am hearing you right, is it fair to say that part of advancing recovery is to scaffold a lot of the recovery practices onto the framework of community inclusion, as a conceptual way of thinking about what you just said?
Mark (15:33): I don’t know exactly what you mean by scaffold, but I do know that some folks have attempted to bring in concepts related to community integration and inclusion and bring it into recovery ways of thinking and terminology. I do have concerns about that, because I think it’s just another way that we’re redefining, rethinking, talking about recovery in the 50th different way or 60th or 70th different way.
(16:06):
Really, the direction that I’ve been thinking lately is keep recovery as is. Recovery is real, recovery is important, and just adopt, as a parallel set of concepts, community integration and inclusion. Don’t try to integrate, don’t try to build upon, don’t try to combine. Just say, “Recovery is the goal. Here’s one way to pursue that goal.” Really promoting community inclusion, supporting people and having opportunities to live a life that they want to live and supporting them with funding, with funded supports and services, and encourage people to do these kinds of things.
(16:54):
Engaging in meaningful activities is important for everybody. I think that this is really missing in current recovery-oriented efforts. If we really believe in recovery, then we should be believing that everybody should be encouraged to work if they want to work. It might not be a 40-hour-a-week job. It might be 50 or 60, or it might be five or ten hours a week. People should be encouraged and supported to go to school, or dating or parenting.
(17:27):
What I like about inclusion that I think bringing in recovery mucks up a little bit is it’s very, very concrete and clear. It’s about doing things that are meaningful to you. What is meaningful to you, and communicating to people, “I believe that you can do this,” and supporting them in pursuing those activities. Very clear, straightforward, not a lot of hocus pocus or hope or quality of life or whatever. Very specific. Asking people, “Are you doing the things you want to do as much as you want to do them?” That is what’s important here.
Livia (18:09): Thank you so much. That’s just really helpful to further delineate your thinking and your thoughts about how to advance recovery. I appreciate it. Do you happen to know anything around federal policies that advance community inclusion that we could point to it?
Mark (18:28): I mean, there are some changes happening right now in the United States related to laws and policies, but these are still on the books and hopefully they will continue to be on the books. Community inclusion is based on the Americans with Disabilities Act. This is signed into law in 1990, and it talks about the rights that people with disabilities, including significant mental health issues, have to live, work, play, pray in the community like everybody else. Another policy initiative is actually based on a U.S. Supreme Court decision called the Olmstead Decision. I won’t go through the whole Olmstead decision, but one of the things that it did is it talked about community integration as being a right for people with significant mental health issues, to live in the community and not be unnecessarily institutionalized. It’s also based on a number of policies related to the President’s New Freedom Commission and President’s New Freedom Commission report.
(19:36):
This is another thing that I think that community integration and inclusion have a bit of an advantage over the concept of recovery, in that recovery is sometimes talked about as a value or a principle, and community integration and inclusion are rights issues. They’re legal rights issues. According to the United Nations Convention on Persons with Disabilities, community inclusion is also a human rights issue, so participation and meaningful activities, as people have recognized it as being important. I think it’s essential for us to adopt this concept in our thinking about how we promote recovery in the mental health system. Not incorporate, not try to blend them in some way, just say, “Let’s use these concepts, principles, laws and policies to promote recovery,” right? Hope and quality of life and empowerment and self-determination, that’s all in the concepts of community inclusion and integration.
Livia (20:51): Thank you so much. Those are just such great reminders of what is out there that we can lean on. Mark, what keeps you going in this work?
Mark (21:03): That is a great question these days, because I have to keep looking for things to keep me going, not because of anything about the field, just what’s going on with our policy discussions right now. What keeps me going, I think, is one is a negative driver, and not negative on my part, but one reason I’m also in this field is I do think that people who experience significant mental health issues experience a great deal of prejudice and discrimination. I think that there’s somewhat of a belief that it’s justified and acceptable to discriminate against people with significant mental health issues, and including among my colleagues.
(21:51):
You mentioned I’m a psychologist. I think within our disciplines, we still see people in ways that are very problematic and prejudiced perspectives about people. That drives me to make those changes, because I still see it happening. I’ve been around a long time now and it’s still going on. I will oftentimes say that that’s my target audience. It’s my people, mental health providers and disciplines, and really getting us to change perspectives.
(22:23):
I’m also driven by a number of examples and stories of people. Really almost every recovery story I’ve ever heard, community inclusion and participation has been part of that story. Somebody who talks about getting to a point in their lives where they weren’t sure they wanted to move forward with their life, and they found somebody who had hope for them and hoped that they could do something and contribute. A lot of the recovery, almost every recovery story I’ve ever heard, work has been part of it. Going back to school has been part of it. Relationships has been part of it. Faith has been part of it. Volunteering has been part of it.
(23:08):
That drives me, because I’ve heard these stories. I’ve seen people who are just amazing, who now know that they can contribute and give something back and enjoy life and do things that are meaningful to them. That’s something I still have been able to maintain a passion for. I’ll do this as long as I can, as long as I’ve got that passion.
Livia (23:36): Well, Mark, thank you so much for your contributions to the field. What you talk about is what we all need, right? We want to make sure that it is indeed something that is accessible and possible for all of us. Well, thank you, Mark. It’s been such a pleasure and thank you for joining us today.
Mark (23:57): Thank you for having me.
Livia (23:58): To our listeners, join us next time on Changing the Conversation.
Erika Simon, Producer (24:03): Visit C4Innovates.com and follow us on LinkedIn and YouTube for more resources to grow your impact. Thank you for joining us. This episode was produced by Erika Simon and Christina Murphy. Our theme song was written and performed by Peter Hanlon. Join us next time on Changing the Conversation.