If you've been engaged in the process of changing your policies and practices to reflect recovery values, you know firsthand just how much commitment and determination it takes to navigate the choppy waters of change and reach the shores of recovery outcomes. We've had a lot of experience with this process ourselves, plus we've watched many others launch into these choppy waters. For most, this seems to be a “sink-swim” process of swimming enthusiastically ahead, sinking back into past unproductive practices, and then surfacing once again and splashing awkwardly toward the shore.
That “sinking feeling” often stems from a simple misunderstanding about the requirements for “transformation.” Transformation is not reformation. It's not just re-forming what exists. It's moving beyond; it's swimming with a different stroke in a different pond. What we see all too frequently are programs trying to re-form what they are already doing. This is like trying to swim while being weighted down, causing the sink-swim effect. It takes so much energy to rise to the surface each time that there aren't energy and enthusiasm left to move ahead.
Let Go of the Past
If this describes your experience, our first suggestion is to stop trying to bring the past into the future. It takes a lot of courage and determination to transform programs, since a lot of factors will pull you backward. But as far as we can tell, transformation is the only way to get to the other side.
You may need to give up some of your traditional practices in order to create new recovery-oriented programs. You may lose some staff members who are unwilling to change the way they work. But once you've let go of the past, you'll find it's much easier to move ahead without the extra weight and resistance.
Once you've let go of the past, take action. This may sound like a no-brainer, but this seems to be the missing dynamic in nearly every change process. There is a lot of talking, plus meeting after meeting, but when it comes time for action, not much happens.
Role Model Recovery
We suggest that your entire program engage in the same process you've been asking of those who use your services. The process is pretty much the same:
Programs ask service users to let go of their past feelings of low self-confidence.
They ask them to become survivors instead of victims of their past.
They ask them to use their strengths to move into new territory and a fuller, richer life that reflects their life goals.
They ask them to own their power and to be self-determining.
While we're asking people to step up and take action, staff often wait for something to happen instead of taking action themselves. Staff can do a much better job of role modeling the courage and determination it takes to bring about transformation. No wonder service users haven't been inspired by the way we go about trying to transform our programs. In fact:
while we are asking them to “own” their power, we are giving ours away;
while we are asking them to not give up, we often have surrendered;
while we are asking them to take calculated risks and move out of their comfort zone, we have not modeled this;
while we are asking them to step into a new way of being, we have held tight to our old ways of doing business and offering services; and
when they don't recover, we say it's because of their illness, instead of taking responsibility for creating programs that will help them get better.
You may be thinking, “What happened to Bill and Lori? They are getting so worked up about this. I read this column to get a few more easy answers, but now they are being demanding and insistent!” Well, you're probably right. We are concerned that the recovery movement will lose ground and that we'll miss this window of opportunity to make real, positive changes. We think this is worth waking you up for, and encouraging you to move ahead, let go of old stuff, and take action to transform your services.
Let's take a closer look at some of the roadblocks to action. When you hit one of these, “kick it up a notch” (as Emeril would say) instead of sinking into surrender. Note how similar these roadblocks are to what individuals go through when they begin their recovery journey.
The belief roadblock. The first step in most personal recovery experiences is believing that recovery can happen. When a person has been stuck in the “mental patient” role for a long time, and has internalized the helplessness and hopelessness of that position, it often is hard for him to believe that recovery is possible. This is true for program staff as well. When they've been stuck in old ways of doing things, it's not easy to let go of them and adapt to more effective ways of doing things. Individuals in recovery often have supports who can hold the hope for them until they can hold it for themselves. This can work for program staff as well: Recovering organizations can hold the hope for each other until each program believes that change is possible.
The planning roadblock. Most people in recovery benefit from making plans they can follow to guide them through the beginning stages. It's important that the plan be theirs, one they own and has meaning for them. This is true for organizations as well. The more employees buy into the change process, the more meaningful it will be, and the more momentum it will build to move the organization into action.
A note of caution here: Don't plan yourself to death. Get a decent plan together and move ahead. We've seen programs spend years developing the perfect plan, but it takes so long that they lose the momentum they need to move it ahead. It's like sitting in your car with the engine running for so long that it runs out of gas before you even back out of the driveway. This is related to the next roadblock.
The waiting-for-perfection roadblock. In order to avoid or manage risk, some programs try to get everything perfect before they take action. Yet by the time they are ready to get started, their plans are outdated.
The permission roadblock. Another common roadblock comes in the form of “waiting for permission.” If you're looking for a reason to backpedal, this one works great. You can spend years waiting for permission from “upstairs.” In fact, “permission givers” can turn over a few times before anyone ever makes a decision. This even can look legitimate to onlookers waiting for something to happen.
We aren't suggesting that you forge ahead without getting the necessary sign-offs; we are suggesting that you step into the process and sell your project to those who can give you permission to move forward. Don't let fear stop you. Don't be intimidated. Don't wait for permission, as this should be a very active phase in which you are doing everything you can to help move things along. Be creative. Look for ways around roadblocks. Provide good information to those who can grant permission so they can feel confident about voting in your favor.
The money roadblock. This probably is the most common roadblock. Here's what it sounds like: “Well, I guess after all that planning, we'll have to give up the entire plan since we've now had budget cuts and can't move forward.” Again, this approach will not move you toward transformation.
Take a look at how you've allocated your funds. Are you pumping a lot of revenue into old programs that don't produce recovery outcomes? If so, be courageous and move money around. Fund new programs that reflect recovery values and drop those that don't. If you don't have enough funding to implement the entire plan, what part of it can you fund that will produce the best recovery outcomes?
Don't let a funding shortfall stop you from moving toward transformation. Get as far as you can with what you have. We often see organizations give up their dreams of transformation in order to continue to fund old programs that don't work well. They can't seem to let go of the old in order to move into the new.
The lost leader roadblock. A lack of good leadership has plagued behavioral healthcare, but it doesn't have to stay this way. Leaders need to hold a vision of transformation so followers can continually see the path. Leaders need to inspire and empower staff and service users. They need to generate choices and options. They need to role model courage, guts, and integrity in ways that move the organization toward transformation.
This column has been about taking action. It has been about figuring out what needs to be done and the importance of overcoming common roadblocks. But we would be remiss if we did not remind ourselves again that figuring out what we want to be precedes figuring out what we want to do.Lori Ashcraft, PhD, directs the Recovery Opportunity Center at Recovery Innovations, Inc., in Phoenix. She is also a member of Behavioral Healthcare's Editorial Board.
William A. Anthony, PhD, is Director of the Center for Psychiatric Rehabilitation at Boston University.
To contact the authors, e-mail firstname.lastname@example.org.Behavioral Healthcare 2008 August;28(8):10-13