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Apply a recovery approach to wellness

October 1, 2008
by Lori Ashcraft, PhD and William A. Anthony, PhD
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Engage clients in “irresistible” services that offer them a healthier life

Last month we introduced you to Paolo del Vecchio, associate director for consumer affairs at SAMHSA's Center for Mental Health Services. Paolo gave us some very interesting information on the endeavors of the 10 by 10 Campaign, which is focused on increasing the life span of people diagnosed with mental illnesses by10 years within the next 10 years. If you missed that column, we suggest you read it as background on what we're sharing with you this month (visit

Two astonishing findings that we highlighted in the previous column were that people diagnosed with mental illnesses in the public system have a life span 25 years shorter than the general population's, and the gap actually has been increasing. This increase is due to both the general population living longer and people in the public system diagnosed with mental illness living shorter lives.

This information instilled in us a sense of urgency about including physical health services in behavioral health programs. So we left you last month with a list of ideas that could kick-start program development for the most prevalent causes of premature death.

This month we are giving you more in-depth information that can help you address this urgent issue by developing services that promote physical health. This venture can make a huge improvement in the quality of life of those diagnosed with mental illnesses. To respond to this challenge and reach the best outcomes, and to also avoid some of the mistakes we've made in the past, we need to be prepared to invest a considerable amount of creativity and ingenuity. Why the cautionary note? Why don't we just get busy and make this happen since it's such an urgent situation? Let's take a closer look.

Living a life that reflects a commitment to wellness is a challenge for all of us, whether or not we have a mental illness. Promoting healthy living is not new, and most of us don't have spotless healthy lifestyles. Sorry to bring this up, but we might as well be realistic about what we're up against so we can outwit the inevitable hindrances along the way.

So what are these “hindrances” we're asking you to outwit as you plan and develop recovery wellness programs? Well, think about it! Look at the death rates from preventable diseases such as heart disease, cancer, obesity, and liver disease. If we all stopped smoking, eating junk foods, overconsuming alcohol, and being couch potatoes, we could prevent most of these diseases. This is a no-brainer, right? Wrong! If it were this easy, we wouldn't have the problem in the first place, and we wouldn't need new programs.

The most formidable “hindrance” we're up against is this: These indulgences are habit forming. And, unlike other preventable diseases, such as polio or small pox, no inoculation can prevent or wipe out these habits. Changing them requires a great deal of individual effort and commitment. Furthermore, individuals have to make these changes themselves. If we had realized the importance of individuals' decision making when behavioral health programs were initially implemented all those years ago, the field could have avoided the mistakes that took us down a road that did not lead to recovery.

Mistakes? Did our field make mistakes? Well-meaning as they were, the two actions that hindered recovery the most were, first, not believing it was possible and, second, thinking people diagnosed with mental illness could not make good decisions and therefore needed to be controlled, managed, and taken care of indefinitely. These mistakes prevented people from being self-determining and from developing the motivation that comes from having hopes and dreams.

So here's the deal: We need to add physical health services built on a foundation of recovery to behavioral health programs. This time we need to take responsibility for creating services that inspire people to participate, instead of trying to force them into it. We need to develop interesting and compelling programs so people will want to participate without being coerced. No small task, we know. Furthermore, skills that inspire and compel are very different from the skills used to control and manage. The following three concepts give us a way to grasp and picture the new skill set.


We talk about this all the time because it's really the most important precursor to producing good outcomes. The first order of business is to establish program protocols that call for the development of relationships with those who use the service. Staff need to know who service users are as individuals. Remember, you are interested in the whole person, not just the unwell part. Engage their “well parts” so they can use them to manage the not-so-well parts. Ask staff to share enough about themselves so they can become a “real person” to the people they serve. This often has been a problem for many professionally trained staff, but we promise you that it's quite possible to share enough information to become a real person to the people being served without causing any problems. This can be done without transgressing any boundaries that often have become barriers to relationship building in the past (see

Once a good connection has been made with the prospective wellness customer and he has been engaged in the conversation, it's time to create interest in what your program has to offer. At this point, it's too early to count on the person's motivation, so staff need to describe wellness services in ways that are irresistible.