Recovery is Central to SC2.0

Stepped Care 2.0 embraces recovery principles. A review of the literature on recovery principles concludes that there are 13 characteristics of the recovery journey that involve five recovery processes (Leamy et al., 2011). Together, these characteristics describe recovery as an active, individual, unique, and non-linear process that occurs in gradual stages. It involves struggle, trial-and-error, as well as multidimensional processes aided by supportive environments that occur with or without professional intervention (Leamy et al, 2011, p. 48). 

Is “Recovery” a Neo-Liberal Ruse?

While there is research supporting the value of these characteristics in contributing to recovery, little research has been conducted to identify specific interventions or practices that may influence these characteristics (Tew et al., 2011). Furthermore, critics argue that without evidence suggesting the recovery model results in positive outcomes, such strategies may be viewed as neo-liberal (i.e., fiscally conservative) policies aimed at reducing both costs and state involvement in mental health care at the expense of vulnerable people (e.g., Field & Reid, 2016).  Field and Reid (2016) argue, prematurely in our view, that the recovery model has failed. Their analysis incorrectly assumes that recovery is a scarce resource and that decisions on state investment constitute a zero-sum game.

Risk and Scarcity

A risk paradigm dominates our society even though: 1) crime and terrorism are decreasing, 2) there are less wars than ever before, 3) mental illness is stable, and 4) global suicide rates are decreasing. Why does the risk paradigm prevail?  Likely because fear is profitable. It leads to vast investment in a forever-burgeoning risk management industry. The military industrial complex is an obvious example. Less obvious is big pharma. But the only way to expand markets for drugs is to create new conditions for treatment. This means broadening what we consider human biochemical frailties that demand chemical intervention. The result is, as former DSM architect Allen Frances refers to, the medicalization of everyday life. Capitalist economies, especially those with limited social investment, function within a scarcity paradigm. Only scarce resources are valued. To maintain the high value of pharmaceuticals, the potential for alternative, naturally occurring, plentiful healing resources must be obscured. The result is we become dependent on a limited set of artificially valued, commodified healing resources.

Synergy Paradigm

If we consider a synergy paradigm, one that has supported indigenous healing systems throughout the ages (Katz, 2018), wellness potential becomes less restricted. We suggest that a synergy paradigm is more appropriate to recovery principles. If well integrated, organized and monitored, the shared social investment of all stakeholders leads to a healing potential that is greater than the sum of the parts. For example, the trust extended from a provider who involves consumers more actively in care decisions improves the therapeutic alliance, which in turn leads to more rapid recovery and increased capacity for providers and consumers to support others. While it is true that recovery principles, long espoused by consumer advocacy groups, and more recently by policy makers, have not yet been well integrated into professional practice (Jacob, et al., 2017), Stepped Care 2.0 provides a structure for such synergistic integration.  More specifically, Stepped Care 2.0 provides a framework for building a collaborative system of care and monitoring that integrates, sustains and extends the contributions of all stakeholders – consumers, providers, decision/policy-makers. Unlike public investments in pharmacare which simply reduce symptoms and create dependency, public expenditure on wellness promotion, upstream recovery-oriented programming like that offered through Stepped Care 2.0 increases capacity exponentially through the mobilization of renewable natural community healing resources. The increased return on investment in synergistic systems is obvious.