C4 Innovations

Community & Behavioral Health | Recovery | Social Change

Principles of Mental Health Recovery

An episode of “Changing the Conversation” podcast

Larry Davidson and Maria Restrepo-Toro discuss the principles of mental health recovery with host Katie Volk. This episode is sponsored by the New England Mental Health Technology Transfer
Center Network (MHTTC).

April 5, 2021

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Katie Volk, Host: [00:05] Hello and welcome to Changing the Conversation. I’m your host, Katie Volk. Today’s podcast is sponsored by the New England Mental Health Technology Transfer Center or MHTTC, and I’m delighted that we’re joined today by the directors of the New England MHTTC, Larry Davidson and Maria Restrepo-Toro. Larry is joining us from Connecticut. Hi Larry.

Larry Davidson, Guest: [00:28] Hi Katie.

Katie: [00:29] And Maria is joining us from Massachusetts. Hi Maria.

Maria Restrepo-Toro, Guest: [00:33] Hi Katie. Thank you for having us. It’s a pleasure to be here with you.

Katie: [00:36] I’m delighted to be having this conversation today about the principles of recovery. It’s something that we talk about a lot amongst our team and in our network. Where I’d love to start, is by talking about what the MHTTC actually is, and then let’s explore some of the principles of recovery. So Larry, I’m wondering if you could give us just a quick overview of the network.

Larry: [1:00] Sure. It’s the partnership made up of the Yale Program for Recovery and Community Health, Beth Israel Deaconess Hospital in Boston, C4 Innovations, and Center for Educational Improvement. And all four partners have come together around the challenge, the mission, of increasing the use of evidence-based mental health practices across the New England region. And we do that by providing training and technical assistance to mental health care providers.

Katie: [1:30] And we’re one of nine regions around the country that are doing this.

Larry: [1:37] That’s correct.

Katie: [1:38] The New England MHTTC’s kind of specialty, so each center has focus areas where they are particular experts in, and ours is around recovery oriented principles. And I wonder, and maybe I’ll toss it to Maria first here, if you could talk about what some of those principles of recovery are?

Maria: [1:58] Yes, our work, meaning that all the training and technical assistance we provide for the region, is actually grounded in these fabulous principles of resilience and recovery. And just to give you an example, the first principle really talks about that resilience or recovery emerging from hope. It’s really endorsing and ground in the work and the belief that everybody that’s coming in contact with us and people that we’re working with, really has that potential to recover, that it is really what is driving all the different services that we are providing. And it is really essential to motivate everybody into this work.

Katie: [2:38] Certainly, and one of the things I love about the work that we do is you see the clinical world, the research world, and the world of people with lived experience really merged together. And Larry, I know that’s something that you feel really passionately about as well.

Larry: [2:54] Yes, Katie. It’s unfortunate that training and providing TA to people in mental health is different from doing that in other kinds of healthcare. Largely, because for hundreds of years, people with mental illnesses were not really considered to be full people. And they were considered to be reflective of the illnesses they had rather than the person who has an illness. And so, we really need to restart mental health care from the bottom up. And we strongly believe that people can recover, and that part of their recovery is being treated like the unique individual that each one of us is.

Katie: [3:29] It’s that difference between “what is wrong with you and how can I fix it?” and “what’s going on for you and how can I help? Or what support do you need?”

Larry: [3:39] Yes, we like to quote the Home Depot motto of “You can do it, we can help.” That’s what we try to teach our mental health providers, to give the [crosstalk 00:03:48] best to their clients, that they can do it, and we have tools and resources that we can help with.

Katie: [3:53] One of the ways that we’ve been doing this is by actually articulating what those principles of recovery are. And I think that’s a step that sometimes gets jumped over, that it’s important to articulate these things and, actually name them, to name what some of those principles are.

Larry: [4:12] Yes, Katie, I think those principles, they’re all important. I’m going to list some of them, not necessarily in order. Recovery and resilience are based on respect. And what that really means is when Larry talk about it before, is that’s really having a deep appreciation for the person as a person, not as a diagnosis. We also understand another principle that is essential to our work is that resilience or recovery are culturally influenced. There’s no right or wrong way to recovery. We all have different paths, very much well in form with our values, preferences, identities, where we’re from. And that’s really essential to understand when we are coming from this perspective. We also understand that it’s family and person driven, that’s a very important part of our work. We understand that everything recovery really is an intentional process that actually places the person and sometimes the family in the middle, trying to really understand what their strengths are. So it’s really a strengths based way of working with people.

Katie: [5:21] One of the things that always stands out to me every time I hear someone talk about the principles or reiterate them, is how much the person is at the center and how much the choice and control sits with them. And also, that there’s no single definition of recovery. What recovery looks like for me may be different from somebody else, and that’s embedded in my culture, in my life experiences, and in how I see the world and what is surrounding me. And Larry, I wonder if you could comment on that a little bit?

Larry: [5:53] Well, yes, Katie, that’s a very good way of capturing what I was trying say before about how mental health is different from other forms of healthcare. With other illnesses, you work to reduce the symptoms and the impairments or the deficits that come along with it, and you hope the person returns to quote “normal.” But in mental health, there really isn’t a quote “normal” to return to. And it’s not just a matter of reducing symptoms or impairments. It’s also a matter of building on strengths, as Maria mentioned. Building on strengths to help the person live the kind of life they want to live with whatever equipment they have with them. So it’s really more about a personal journey that needs to be defined by the person him or herself rather than returning to some vague or universal sense of normalcy.

Katie: [6:42] Yeah, certainly. And I wonder if for the folks that are listening to this, they’re often on the provider side of things or on the practitioner side. And I wonder if there’s an example that comes to mind for one of you about what this looks like in practice. If I’m a practitioner, and I’m working with somebody, what does this look like when it’s actually on the ground? Maria, what do you think?

Maria: [7:09] I think that if you’re working as a practitioner, one way that this could come to life is this kind of work is done in collaboration. So we are, as you mentioned before Katie, it’s holistic, and we’re actually working together. This is a kind of work we approach in a partnership because as Larry mentioned, this is not about treating the disease. It’s about working with the person. It’s a good way to see if we are embracing this model is if we are working and centering the work around the goals. What are the person’s goals and aspirations? How do they want to live in the community? What kind of life they want to have?

Larry: [7:47] And that’s captured in the kind of concrete details that we might otherwise overlook if we didn’t understand that the person was battling with a disability, and mental health conditions can be disabling. And those are the folks that we’re most concerned about helping. But for someone like that; who’s besieged by voices, and has difficulty keeping their thoughts together, and gets very scared of other people, and the things that they might want in their lives are different from what we might expect. One middle-aged man I was working with many years ago, wanted to cook his own cheese omelet, and that was a very important thing for him because he loved the way he made his cheese omelet, that nobody else could quite make. And another person talked about when he felt well enough, he borrowed a friend’s dog and took it for a walk. These can be very concrete, seemingly small actions, but for someone who’s seriously disabled, it can be the difference between a day that’s worth getting out of bed for, or a day where you have no reason to get out of bed.

Katie: [8:51] Yeah. And I think it’s those seemingly small things that make a life and recovery so rich, and that the recovery principles illuminate, because all of the examples that came to mind for me when you both were talking, were those things. My goal is to be able to see my grandchildren, or go for a walk with a friend, or those seemingly simple kinds of things, but that really make up the kind of fabric of our wellbeing in a really holistic kind of way. That’s less about symptom reduction and more about what we want our lives to look like.

Maria: [9:26] You mentioned at the beginning lived experience. I think another way that a practitioner can recognize this is, we really embrace working with peers and honoring one’s lived experience, and we all have different lived experiences that we can bring into our work. And, a very powerful experience is when you meet somebody that has been in the same situation you have, and that inspiration that comes along [with] that, understanding that it’s not necessarily only the clinician’s role to get the job done, but this is, again, I go back to the togetherness. This is some kind of a journey that we’d work together with the person. It’s not, we are doing it to the person, but we are with the person. And, that’s definitely connecting with other people that have had the same experiences, it’s a very important ingredient in recovery as well.

Katie: [10:20] Absolutely. I want to shift our conversation a little bit because one of the things I know that we’ve talked about it since the beginning of talking about recovery oriented principles in our network. But I think over the last year especially, it’s really come to light is this issue of equity and social justice and how that dovetails or overlaps with some of these principles. And I wonder if Larry, and then Maria, if you could comment on that.

Larry: [10:51] Well, we have mentioned that our MHTTC is unique in its own way, in terms of being based in the principles of recovery. Similarly, it’s unique in that it’s based in a social justice human rights framework. So, we view people with serious mental illnesses as people who have been objects of discrimination and who have had their rights denied them in the past. And so, social justice and promoting in human rights perspective has been integral to the recovery movement from the very start, because it was started by people in recovery themselves, who had been hospitalized against their will. So in that sense, we have the foundation already in place for identifying discrimination and stigma and for pushing back from a human rights perspective. But it’s been important over the last six months to build on that foundation by incorporating understandings of structural racism and other forms of discrimination as well, because the person doesn’t just have a mental illness. They may also be a person of color, they may also be a woman, they may also be a person with a physical disability, so the vision of intersectionality.

Larry: [11:59] There are many ways in which people can have their rights denied to them. So we have rewritten our principles to incorporate a more explicit focus on structural racism, and pushing back against various forms of discrimination, in addition to the one against people with mental illness.

Maria: [12:18] Absolutely. We are totally committed to actively actually addressing these issues, not only as a team, but also as a Mental Health TTC Network as well. In two concrete examples maybe I can give is, when we talk about these principles of resilience and recovery, we always think about social networks, and collective action, and roles in the community. So, when we are working with this lens, we understand that, as Larry just said, that people have been discriminated against. So we also tap into this collective action to heal, and we see that that’s instrumental, so we don’t hold up the answers. We also seek the community in a participatory way to inform the process. And, another way it’s important that we really understand in addressing trauma. And trauma can come from many kinds of traumas, but also racial pressure, and systemic pressure play into this equation. So we also endorse working from a trauma informed way, and that’s another active ingredient of these principles that are going to help us move along this process of social justice.

Katie: [13:31] I’m conscious of the fact that we’re now a year into the pandemic, and although we do see glimmers of hope here and there, we’re still in the midst of it, and there’s certainly a lot of suffering for people going on; both people who were in recovery prior to the pandemic, thinking about these things prior to the pandemic, and certainly who’ve had experiences over the last year that has really challenged our mental well-being and physical well-being. And, so where do you find hope? Where do you find resilience yourselves?

Maria: [14:04] For me, there’s no accident that I got into this work, and I’ve been doing for so many years because I think I have faced many challenges in my life, but I find a lot of the strengths in my own culture, in my cultural roots, in my family, in my traditions, that kind of sustain me. But, also I think my work gives me hope. I think by having the honor to be doing this kind of work for so many years, and bringing training as a way of hope. I mean, I do actually intentionally like, and I acknowledge the privilege that that brings, when we are talking to people and providing information about maybe different ways of training and having conversations with people around this kind of work. So, I think both, it has been first and foremost, personally informed, but also through my work. And, I do believe that I keep learning every single day and find resilience depending on where I am in my life from different sources.

Katie: [15:09] Similarly, I find hope when I come to work almost every day. And Larry, I’m wondering, where do you find hope and resilience these days?

Larry: [15:22] I’ve had a need to find hope over the last four and a half years, going through the very difficult political times before the COVID started. So, it’s a very relevant question for me. I’ve been very blessed to have three daughters. And I look to their generation as the saving grace, that they are all three very social justice oriented, they’re all three of our advocates, and they’re all three going to help us make this a better world along with their peers.

Katie: [15:51] I think the same thing about my students and my oldest son, especially. They have an analysis around social justice that I don’t think I developed until well into my twenties.

Katie: [16:01] I appreciate you both really taking the time to think and reflect with us. I’ll say to our listeners that many of the things that we talked about today, if you look in the show notes, you’ll see that we’ve linked to the principles of recovery and to the new England MHTTC website. So, if you want to learn more, you can check that out. But, in the meantime, I’ll just say, Larry, thank you so much for being here.

Larry: [16:25] Thank you for having us, Katie.

Katie: [16:27] And Maria, it’s always a pleasure to talk with you as well.

Maria: [16:30] Katie, thank you. It’s so wonderful seeing you and talking with you. Thank you for having us.

Katie: [16:35] And to our listeners, join us next time on Changing the Conversation.

Erika Simon, Producer: [16:39] Visit c4innovates.com and follow us on Twitter, Facebook, LinkedIn, and YouTube for more resources to grow your impact. Thank you for joining us. This episode is sponsored by New England Mental Health Technology Transfer Center and was produced by Erika Simon and Christina Murphy. Our theme song was written and performed by Peter Hanlon. Our host for this series is Katie Volk. Join us next time on Changing the Conversation.

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