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The Making of Mental Health Policy
Author BioNora Jacobson is the author of Cleavage: Technology, Controversy, and the Ironies of the Man-Made Breast. She works as a scientist for the Health Systems Research and Consulting Unit at the Centre for Addiction and Mental Health in Toronto and is an assistant professor in the Departments of Psychiatry and Public Health Sciences at the University of Toronto.
Main DescriptionFor hundreds of years, people diagnosed with mental illness were thought to be hopeless cases, destined to suffer inevitable deterioration. Beginning in the early 1990s, however, providers and policymakers in mental health systems came to promote recovery as their goal. But what does recovery truly mean? For example, to consumers of mental health services, it implies empowerment and greater resources dedicated to healing; to HMOs, it can suggest a means of cost savings when benefits cease upon recovery. This book considers "recovery" from multiple angles.
Traditionally, Nora Jacobson notes, recovery was defined as symptom abatement or a return to a normal state of health, but as activists, mental health professionals, and policymakers sought to develop "recovery-oriented" systems, other meanings emerged. Jacobson's analysis describes the complexes of ideas that have defined recovery in various contexts over time. The first meaning, "recovery-as-evidence," involves the theories, statistics, therapies, legislation, and myriad other factors that constituted the first one hundred years of mental health services provision in the United States. "Recovery-as-experience" brought the voices of patients into the conversation, while "recovery-as-ideology" drew on both recovery-as-evidence and recovery-as-experience to rally support for specific approaches and service-delivery models. This in turn became the basis for "recovery-as-policy," which developed as assorted representative bodies, such as commissions and task forces, planned reforms of the mental health system. Finally, "recovery-as-politics" emerged as reformers confronted harsh economic realities and entrenched ideas about evidence, experience, and ideology.
Throughout, Jacobson draws on her research in Wisconsin, a state with a long history of innovation in mental health services. Her study there included several years of fieldwork and interviews with the government-appointed groups charged with making recovery policy. Thus, In Recovery also provides an inside account of the process of policy development and implementation.
ReviewsAs a result of her systematic observations, she has written a textbook that reads like a novel and provides an in-depth understanding of the history of recovery concepts, along with detailed descriptions of how such concepts can be implemented meaningfully across mental health systems. In Recovery is a must-read for all students of and participants in the transformation of mental health systems in the 21st century.
In this closely documented, carefully reasoned and deeply instructive work, Nora Jacobson shows how the cause of 'recovery' in mental health practice plays out in one state. Jacobson was beautifully positioned to observe the horse-trading and semantic wrangling that determine the fate of high-minded ideals when translated into policy. Rhetoric, alliances, timing and persistence turn out to matter every bit as much as science.
Table of ContentsAcknowledgments
A Research Memoir
My Own Private Wisconsin
Four Scenes from the History of Recovery
A Simple Yet Powerful Vision
From Bones to Bridges
Making It Public
The State of Recovery