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What does a recovery-oriented system of care look like in practice? As we suggested in the preceding chapters, the primary aim of recovery-oriented care is to offer people with serious mental illness a range of effective and culturally responsive interventions from which they may choose those services and supports they find useful in promoting or protecting their own recovery. In addition to diagnosing and reducing symptoms and deficits, a recovery-oriented system of care also identifies and builds on each individual’s assets and areas of health and competence to support that person in achieving a sense of mastery over his or her condition while regaining a meaningful, constructive sense of membership in the broader community (Davidson et al., 2007). While the goal of recovery-oriented care may appear, in this way, to be relatively clear and straightforward, the ways in which care can be used to promote recovery are neither so clear nor so straightforward—neither, unfortunately, are the ways in which care, as currently configured, may impede or undermine recovery. The following practice standards are offered as a beginning roadmap of this territory, bringing together what we think we know at this point about how care can best promote and sustain recovery, and how care may need to be transformed to no longer impede it. These standards are drawn from over two years of conversations with practitioners, people in recovery, families, and program managers and are informed by the current professional literature on recovery and recovery-oriented practice. These standards focus primarily on the concrete work of practitioners and provider agencies so as to provide practical and useful direction to individuals and collectives that are committed to implementing recovery-oriented care. We recognize, however, that many of the practices described will require a broader commitment of agency leadership to significant and ongoing administrative restructuring. In the future, we also anticipate that systems will want to add domains to the ones we propose here, in such areas as prevention, early intervention, cultural competence, and the assessment and monitoring of outcomes.

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.