Medical Model? Recovery Model? No Problem

Regarding the treatment of serious mental Illness (SMI), there is currently a fundamental rift between two camps, one known as the "Medical Model," basically scientific psychiatry, and the "Recovery Model," based of personal experience, learning and support. Bad feelings, misspent public funds, and bad medical outcomes have resulted from this apparent dichotomy.

This is all competely unnecessary. In well-run programs for the people with SMI, these issues never arise. Boths approaches are melded into a seamless fabric of excellent care. At Napa State Hospital, where I work, we use a combination of the Medical Model and the Recovery Model. Used together, they work wonders. It's one of the reasons we have such a high recovery rate.

But here's the key. Everyone, and I mean everyone, is clear about what we are dealing with and how we do it. We function on the medical model first and foremost. Proper medication management is the bedrock treatment for SMI. Period. Of this, no one at Napa has any question. After active symtoms are under control, however, then the WRAP plans, groups, and peer support—a complete array of Recovery Model therapy appraoches—are applied to deal with the cognitive and behavioral issues that will be so necessary for a person suffering with SMI to function in the community.

The problems arise when you put the cart before the horse. When you try and do therapy or peer support and anything else in the Recovery arsenal while people are still actively sick. The Recovery Model works for people who have been made well by their medications. Psychotic people can't do therapy. Everyone knows that. First we get them well. Then they can use the vast array of effective therapy tools effectively. And if there is relapse of symptoms, it means a readjustment of medications.

This combined model is used by the most succesfull outpatient treament progrm for SMI—the California statewide Conditional Outpatient Release Program (CONREP). CONREP handles the supervised care for most SMI patients relesased from California state hospitals. Medication adherence and group attendance is mandatory. And if a person fails on either count, they go back into the hospital. This is the only truly functional model for treatment of SMI. It may ruffle some feathers, it may be expensive, but it's the best. By far..