An Environment That Promotes Recovery

By Christine Palmieri

‘Recovery’ is a word that gets used a lot in the world of mental health and addiction services, sometimes so much so that I think we can easily lose sight of what it represents. In my role with the Mental Health Assoc. (MHA), I often have the opportunity to talk to newly hired staff about the idea of recovery. We discuss what it means and what it can look like in the context of working with people who have experienced trauma, homelessness, psychiatric diagnosis, and problems with substances.

When I ask new staff the question, “what does it mean to recover?” I frequently hear things like “getting better” or “getting back to where you were” or “having a better quality of life.” Although I tell staff there are no wrong answers to this question, secretly I think there are.

As with many things, I think it’s easier to talk about what recovery is by defining what it isn’t. For me, recovery isn’t a cure. It isn’t a finish line or a place people get to. It isn’t a goal that can be neatly summarized in a treatment plan. I believe recovery is a process that is unique and intimately personal to the individual going through it.

As providers of services, or as loved ones, community members, and policy makers, I don’t believe it’s up to us to define what recovery means or looks like for people going through it. Each person needs to examine and define what it means to them. For the rest of us, I think the more important question is “what makes recovery possible?” When the question is posed this way, we are able to engage this idea of recovery in a much different and more productive way. This question offers the opportunity to share the responsibility and partner with those we support.

The analogy of a seedling is often used when describing this process of recovery, and one I use when I talk to our new hires about their roles and responsibilities as providers of service. Seeds are remarkable little things. For me, they represent unlimited potential. A seed no bigger than a grain of rice contains within it everything it needs to grow into a giant sequoia. But no seed can grow without the right environmental conditions. No amount of force or assertion of control can make a seed grow. It needs the right soil, the right amount of water, and the right amount of light to sprout and take root.

In the same way, within each person who has experienced trauma, homelessness, psychiatric diagnosis, or problems with substances, I believe there lies unlimited potential for growth, and each person needs the right environment for the process of recovery to take place. As providers, loved ones, community members, and policy makers, we very often control that environment. Metaphorically, we provide the soil, the water and the light.

Soil is the place where recovery begins. It offers a place for the seed to grow roots, to gather strength, security, and safety. Soil is what keeps trees rooted tightly to the ground through storms. It is our responsibility to offer environments where people in recovery feel safe and secure, to try out new ways of coping and managing the difficulties and challenges life presents to all of us.

Water provides a seedling with essential nourishment. We need to find ways to support people in recovery to discover what truly nourishes them. The work of recovery is hard. It requires taking risks and feeling uncomfortable. We cannot do the work of recovery for anyone else, but we can and should work to help people in recovery find the supportive relationships, meaningful roles, and reasons to do that hard work.

Light provides the energy necessary for growth. In recovery, I believe light is offered through the hope and understanding that every person has within them the potential to live a full and active life in the community. As providers, loved ones, community members, and policy makers, it is our role to shine the light of hope for people who have experienced discrimination, loss of power and control, and in many cases a loss of their identity. –

Christine Palmieri is vice president of the Division of Recovery and Housing at MHA.

Suicide Rates Up in Massachusetts

By Dr. Barry Sarvet

Far too many individuals in our community have been lost to suicide. Many of the people who die from suicide have serious behavioral health conditions, including depression, which have never been diagnosed or treated. We still have an enormous amount of work to do to improve access to care for individuals suffering from depression, substance-use disorders, post-traumatic stress disorder, and other conditions associated with suicide.

Suicide rates in the U.S. have increased nearly 30% since 1999, according to the latest data from the Centers for Disease Control and Prevention (CDC). In Massachusetts, the suicide rate increased by 35.3% between 1999 and 2016, making it one of only 25 states where the suicide rate increased by more than 30%.

We don’t have clear answers regarding the cause of this increase. It is suspected that the opioid epidemic is a factor, but other possible causes include increasing levels of stress and increased social isolation in contemporary society. Increased prevalence of economic hardship in the context of growing income disparity is also a likely factor.

Mental-health conditions are often seen as the cause of suicide, but suicide is rarely caused by any single factor. In fact, many people who die by suicide are not known to have a diagnosed mental-health condition at the time of death. Other problems often contribute to suicide, such as those related to relationships, substance use, physical health, and job, money, legal, or housing stress. 

Because suicide is also a significant public health problem in the adolescent and young adult population, it is important for parents and caring adults to learn how to recognize depression. In teenagers, depression is often complicated by disciplinary problems, school underachievement, interpersonal conflict, and drug and alcohol problems. It takes a great deal of understanding and compassion to notice the depressed person in the middle of all of this, who may be at serious risk for suicide.

The National Institute of Mental Health warns that people who threaten, talk, or write about death, dying and suicide, or who seek access to a means to hurt or kill themselves, are exhibiting suicidal behaviors and are at risk of suicide.

If you have a loved one exhibiting such behaviors or thoughts, you should ask them what you can do to help. You can point out your observation that they seem sad and can encourage them to get help initially through their primary-care doctor, who can assess the situation and prescribe medications or make a referral to a mental-health professional.

People who attempt to take their own lives often are profoundly hopeless and need people around them to notice their suffering and to help them to seek treatment. It’s important to learn about the signs of depression, substance-use disorders, and other common behavioral-health conditions. It’s time for us to let go of the stigma that has made it so difficult for people to talk about these things.

Suicide touches everyone. The suicide death of a loved one or close friend can have a profound impact on survivors who often feel partly responsible for the tragedy. Many times they are left feeling guilty and wondering what they could have done differently and questioning how they could have missed the signs.

If you, or someone you know, is in suicidal crisis or emotional distress, call the National Suicide Prevention Lifeline at (800) 273-8255 or the Psychiatric Crisis Team at (413) 733-6661 for Springfield residents or to learn where to call outside the Springfield area.

Dr. Barry Sarvet is chair of Behavioral Health at Baystate Medical Center.