The federal government has recently undertaken a major initiative that will transform the way services for those diagnosed with serious mental illness are provided, based on the "recovery" model. Involving almost 20 federal agencies, this initiative is complex; in brief, it involves transforming the current mental health delivery system to one that maximally recognizes the importance of promoting hope, autonomy and empowerment for those in recovery. This model also entails shifting our focus from curing mental illness (or at least reducing the symptoms associated with it), to providing the accommodations, supports and rehabilitative services that will enable people suffering from the disabilities associated with long-term mental illness to lead safe, dignified and full lives in the community. It is important that psychology embrace the recovery model and participate fully in the transformation of the mental health system. I would even go so far as to suggest that this is an initiative that psychology is uniquely qualified to lead.
President Bush's New Freedom Commission on Mental Health brought the notions of recovery and transformation to center stage (see page 28). The commission identified as its first goal that "Americans understand that mental health is essential to overall health." This goal then had two objectives:
Addressing the stigma associated with mental illness.
Addressing mental health with the same urgency as physical health.
These two objectives lead the way to the transformation of the mental health system. Adopting a recovery model involves purging the last vestiges of stigma and coming to view and treat mental illnesses as illnesses just like any other. This argues for the adoption of meaningful parity legislation, for which APA has consistently and enthusiastically advocated.
The idea that mental illnesses are illnesses like any other is not new to psychology. Psychologists have for a long time investigated, and attended clinically to, the psychosocial dimensions of illness, whether they were dealing with schizophrenia or diabetes. Psychology's focus on behavioral processes has undermined the traditional Cartesian dichotomy between the "mental" and the "physical." We know that so-called "physical" diseases have psychological, social and behavioral elements, just as we know that so-called "mental" diseases have neurobiological and neurophysiological elements. We do not have to look far beyond the boundaries of our own discipline to identify the resources needed to effect transformation to a recovery-oriented system of health care--a system in which mental and physical illnesses are treated with the same urgency, and the people suffering from them are treated with the same degree of dignity, respect and compassion.
Psychology's natural leadership is evident when we look at the emerging roles and practices that will be associated with a transformed system. When communities seek to provide crisis response in the context of either large scale traumatic events (such as Hurricane Katrina and 9/11) or acute individual psychological distress (analogous to medical emergencies), who will be best prepared to provide the services and train the crisis staff in psychological first aid? When schools seek to offer mental health education and mental illness prevention programs to adolescents, who will have the experience and expertise to develop the curricula and to design and deliver early identification and intervention services?
Mental illnesses will be viewed and treated like physical illnesses when they come to be understood to be illnesses like any other. In embracing this viewpoint, psychology does not need to fear being subsumed by medicine. This fear might have been appropriate when psychology was first struggling to establish its identity as a discipline in its own right, distinct both from philosophy and the natural sciences. More than a century later, a mature field of psychology is now in a position to facilitate the integration of mind and body, and to bridge the ravine cut by stigma between real ("physical") illnesses and not-so-real ("mental") illnesses.
As more states approve prescriptive authority for psychologists, and as more psychologists become involved in the provision of primary psychological health care, we are increasingly in the position to reverse the myth that mental illnesses exist "only" in people's minds. We suggest, to the contrary, that the mind is present in all illnesses, not just those traditionally considered to be mental. It is now up to us to demonstrate the ways in which this knowledge can be used to improve the health and well-being of all of our citizens.