"It is essential that we make the shift from the acute care model, we know doesn't work, to the recovery model."

My first day in the city of Philadelphia Department of Behavioural Health and Mental Retardation Services (SBHMRS) was spent meeting my contact here, Jennifer Sears, and Roland Lamb, Director of the Office of Addictions Services, to review my schedule.

I’ll tell you more about the remarkable Professor Roland Lamb in future blogs as I’ve got several more meetings arranged with him over the next two weeks and we’re also dining out together next Tuesday (9th November) after I’ve listened to him delivering a lecture at the University here.

I’ll give you a taster, however, to be getting on with. This is his way of describing what working in a peer-based, recovery-oriented service delivery system is like as opposed to the previous acute treatment system of care. “At one time I used to drive the bus. Now, I just sit in the back and pay for the petrol.”

Perhaps at this stage I should tell you a little about SBHMRS itself. The department, under its Director Arthur C Evans, PhD, is responsible for administering a broad array of treatment, intervention and prevention programmes for individuals and families impacted by mental illness, addiction and mental retardation. More than 112,000 people are served each year through a $1 billion annual budget.

The behavioural health component comprises the Office of Addiction Services, the Office of Mental Health (OMH), and Community Behavioural Health (CBH). These entities provide a full range of mental health and substance abuse treatment for approximately 100,000 adults and children annually through a network of community-based providers.

Mental Retardation Services (MRS) is responsible for the development, coordination, and monitoring of services for children and adults with mental retardation. MRS contracts with approximately 70 provider agencies to serve more than 12,000 people annually. MRS provides case management/supports coordination, in-home and residential services, early intervention, family support, day programme, and employment services.

As Dr Arthur Evans, the man responsible for the transformation of Behavioural Health Services to Recovery-Oriented system of care, explained to me over lunch today (Tuesday 2nd November), “My philosophy and belief about recovery is that it is essential that we make the shift from the acute care model, which we know doesn’t work, to a recovery model. And what that means to me is that it’s about the “why” we do treatment; it’s about the “how” we do treatment; and it’s about “what” treatment.

The “why” being, that ultimately our goal should be to help people to obtain the best possible life that they can for themselves. And in the traditional system which is focused on symptoms and the management of symptoms, that is not necessarily the view. So it shifts the “why” to much more about people having a life in the community, the kind of life that any one of us would want to have.

It shifts the “how” because for many years our field has been professionally driven and the recovery philosophy is about partnering with, standing beside the person who’s going through the process and, whether that person is a treatment professional or a person who‘s also in recovery, it about how do you partner with, become a coach or facilitator, or a support for someone who’s going through that process.

And it also shifts the “what” in treatment because it opens up many more options for folks. So, in a traditional system that is focused on symptomology and managing symptoms, the focus is on narrow sets of interventions that are focused on those particular issues. But when one moves to a recovery orientation, which is about having a life in the community, it really opens up a much broader array of services and interventions that we need to bring to bear to help folks.

So, for me, it’s about the “what” the “how” and the “why” of treatment and making that, both the philosophical shift, but then doing the real hard work of ensuring that our practices and our policies and how we finance and how we organise our service systems are aligned with that philosophy, are aligned with those practices.”


Initiatives, as was pointed out to me by Peg Minehart, the Medical Director, are geared towards encouraging the use of evidence-based practices, improving the cultural competency of all care providers, eliminating behavioural health disparities and heightening sensitivity around providing trauma-informed treatment strategies. Standard policies promoting individual choice, consistency of operations, and access to services for people with mental retardation are also being delivered.

In the afternoon, I was privileged to attend PROACT (Pennsylvania Recovery Organization – Achieving Community Together) for a Family Member Story-Telling Training session facilitated by Joan Kenerson King (who created the training model) and Jazmin Banks.

The room was packed for this wellness and recovery oriented training session which recognises that the stories of Family members are a critical tool in moving Systems Transformation forward.

“All sorrows can be borne if you put them into a story or tell a story about them”, so said Isak Dinesen.

Therefore, SBHMRS, in conjunction with the Philadelphia Compact, are sponsoring free trainings especially for family members of children and/or adults who have received mental health (MH) and/or substance abuse (D&A) services in the city of Philadelphia.

I stayed for the whole session and the RECOVERY in that room this afternoon was palpable. This was not only a training session but a moving and healing experience for all of us. Joan King has a magical quality about her and her conviction to the cause is inspirational. I was invited to tell my story at the end of the session.

A gardener once told me, “Wynford, if you’re ever in trouble – give, give, give.” And that’s been my philosophy throughout my recovery. Focussing on others takes me away from my pain. It’s always worked in the past – becoming a “giver” instead of a “taker”. And I saw it work again this afternoon. The blessings one receives from simply telling your own story are immeasurable. I saw people physically change, their postures straightening, their expressions mellowing and peace descending on what had previously been some very troubled and anxious souls.

And that’s why I’ll be taking this particular training model back home with me to Wales.

And the music I’m listening tonight is – Bobcaygeon sung by Damhnait Doyle, Lights down Low.

Nos dawch pawb. Diolch am ddarllen am fy nhaith yn America.

Good night, everyone. Sleep tight.