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We begin with a snapshot of the world we hope to leave behind. While it may not be necessary to reiterate the reasons why transformation is needed for most readers—who, as we noted in the Introduction, may be only too familiar with the challenges presented by our current systems of care—we think it useful nonetheless to establish a point of departure. We also strive throughout this volume to make our ideas concrete through the use of stories derived from our own experiences, putting a human face on what might frequently appear to be abstract or idealistic concepts. In our experience, and in our previous publications (e.g., Davidson, Stayner, et al., 2001), there has been very little about mental health concepts of recovery that are either abstract or idealistic. In fact, we have consistently stressed the everyday nature of recovery (Borg & Davidson, 2007), fi nding it embodied and exemplifi ed in such mundane activities as washing one’s own dishes, playing with a child, or walking a dog. We strive to continue this concrete focus in what follows, alternating our exposition of principles and practices with descriptions of real-life examples from our practice. This not only is our own preference in teaching and training but was strongly encouraged by the reviewers of an earlier draft of this book. We are happy to oblige. Passage of legislation such as the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990 held great promise for individuals with disabilities, especially in relation to their opportunity to participate fully in all aspects of community life. Unfortunately, it is now widely recognized that the implementation of these acts for persons with serious mental illness lags far behind parallel efforts in the broader disability community, with expectations for expanded access and opportunity largely still to be realized (Chirikos, 1999; Fabian, 1999; Hernandez, 2000; Wylonis, 1999). In response to this national tragedy, several recent calls have been made for radical reforms to the mental health system. The Surgeon General’s Report on Mental Health, for example, called for mental health services to be “consumer oriented and focused on promoting recovery” (DHHS, 1999, p. 455).

The second chapter begins with descriptions of some of the many ways in which people with serious mental illness are key agents in their own recovery. In these descriptions, we fi nd that the cornerstones of recovery are both the hope that a better life is possible and the desire the person has to pursue such a better life once this hope has taken root. For an individual, both hope and action appear to be required to make recovery a reality. As we begin to understand more fully the role of systems of care and of the practitioners within those systems in facilitating recovery, we suggest that achieving, in the words of the New Freedom Commission report, “profound change—not at the margins of a system, but at its very core” also will require both hopeful attitudes and concerted efforts. While the remaining chapters in this volume will deal more explicitly with the kinds of concerted efforts required to achieve transformation, this chapter focuses primarily on attitudes toward recovery and the kinds of concerns systems and practitioners have raised (to date) as they have gone about the process of understanding and implementing recovery principles in practice. It has been our experience, however, that the federal mandate to transform systems of care to promote recovery has left many policy makers, program managers, practitioners, and even the recovery community itself under increasing pressure to move to a recovery orientation without fi rst examining the concerns of stakeholders within those systems about this new notion of recovery and its implications. As a result, we are all at risk of overlaying recovery rhetoric on top of existing systems of care, failing to effect any real or substantial—not to mention revolutionary—changes due to our urgency to just “get it done.” In this chapter, we pause to consider some of the more common concerns we have encountered in attempting to introduce and implement care based on the vision of recovery that we have articulated thus far. Addressing these concerns, we believe, is a necessary fi rst step in changing the attitudes that underlie current practices in the process of replacing these attitudes with the more hopeful, empowering, and respectful attitudes demanded, and deserved, by people in recovery.