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Barkley soon brought his family to join him in Washington, DC. He found a hero in Woodrow Wilson and supported the president’s progressive New Freedom. Barkley’s first House speech strongly supported the Underwood Tariff. The speech contained elements common to many of his talks over a lifetime; he poked fun at the opposition, and he included one of his famous stories. His only committee assignment was the exclusive Interstate and Foreign Commerce. Early meetings between Barkley and the president concerned patronage issues. Along with the tariff, the Federal Reserve System, and the Federal Trade Commission, which Barkley helped prepare, the passage of the essential features of New Freedom reinforced for congressman and president the importance of party. Meanwhile, through press releases, mailings, and personal correspondence, Barkley kept in close contact with his constituents.

Wilson’s first year in the White House proved as successful as his governorship in enacting progressive reforms. By 1914, he had become one of the more successful presidents in American history domestically. As his presidency unfolded he continued to transfer to the nation prerogatives formerly reserved for the church. America, in his view, became the central agent of righteousness in the world. But progressivism was primarily for whites. Race and, to a lesser extent, gender remained impervious to Wilsonian reform. After assuring African Americans of equal justice, Wilson oversaw and defended the segregation of several departments of the federal governments, much to the chagrin of African American leaders who had supported his election.

This chapter examines the Progressive era, which started from the 1890s and spanned the 1910s. One cannot make sense of this kaleidoscopic movement unless one incorporates the missing piece to conventional accounts of it: the movement’s debt to Anti-Federalism. Both the Democratic and Republican parties could claim the Progressive mantra at the turn of the twentieth century because it was Federalism and Anti-Federalism in more perfect equipoise than possibly any other movement in American history. Although the historical consensus appears to be that the era is to be remembered by the fierce “New Nationalism” of Theodore Roosevelt, it is just as well, if not better, understood by the romantic idealism of Woodrow Wilson’s “New Freedom” and the philosophy and spirit of Anti-Federalism.

This chapter discusses the importance of clinical outcome data in improving the quality of care for those struggling with serious mental illness so that they can have a life of recovery in their home community. It first provides an overview of clinical outcome data and clinical outcome research before emphasizing the importance of outcome-oriented and evidence-based practice in the field of mental health, along with the reasons why providers are reluctant to use outcome measures. It then evaluates Virginia's outcome-oriented pilot project called the Performance Outcomes Measurement System, the Substance Abuse and Mental Health Services Administration's national outcome measures for mental health services, and the New Freedom Commission on Mental Health's identification of major problems in the mental health service system and potential solutions. It concludes by presenting recommendations aimed at transforming America's mental health service system.

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.