MAPP Offers Comments on Recovery Oriented Care
(Editor's Note: In September 2011, the Office of Adult Mental Health Services released a request for final input on proposed Practice Guidelines for Recovery Oriented Care. MAPP responded to the OAMHS request with the following comments.)
November 18, 2011
To: Mr. Guy R. Cousins, Acting Director of Adult Mental Health Services
Re: Recovery for ME Mental Health Services: Practice Guidelines for Recovery Oriented Care, Draft: September 2011
Dear Guy:
As President of the Maine Association of Psychiatric Physicians (MAPP), I appreciate the opportunity to provide comments on behalf of MAPP on the draft document referenced above. We recognize the effort of the many individuals and organizations that went into developing the 24 page document which provides a vision of what a mental health system in the state would look like based upon the principles of Recovery Oriented Care. We support many of the principles and guidelines set forth in the document and we look forward to a robust discussion about the implications of moving to a Recovery Oriented Care System. As is noted in the document, the work of continuing to develop, refine and implement practice guidelines for recovery-oriented care will be a collaborative process, involving all of us. We do not view the document as an end point, but rather the beginning of a collaborative process that will refine and evolve the processes to evaluate how services support recovery.
As you know, the American Psychiatric Association and the American Association of Community Psychiatrists have prepared a detailed situation analysis of Recovery-Oriented Practice, published on April 27, 2011. The report summarized the information-gathering efforts of the first year of a multiyear project to develop and disseminate educational materials for psychiatrists to help further the use of recovery-oriented practices. The project is a collaborative effort of the APA and the American Association of Community Psychiatrists with assistance from an advisory group of psychiatrists, other mental health professionals and consumers. The project is part of a larger Substance Abuse and Mental Health Services Administration (SAMHSA) effort to broaden and increase awareness, acceptance, and adoption of recovery principles and practices among mental health care providers. Organized psychiatry generally and MAPP specifically are not opposed to joining the rest of medicine in attempting to move to systems of care which are patient centered and recovery-focused. But change of this magnitude takes time and we must always guard against the possibility of unintended consequences that could be harmful to patients.
Toward that end, we recommend a series of meetings among stakeholders to fully evaluate the potential implications of these guidelines. Specifically, the meetings should address, at a minimum, the following issues;
1. Whether adoption and use of the guidelines has fiscal implications. For instance, the need to pay for consumers to review care and the addition of consumers as board members may both have negative fiscal implications.
2. Whether the guidelines are consistent with established standards of medical practice, as enforced by the Board of Licensure in Medicine and the Board of Osteopathic Licensure.
3. Whether practice under the guidelines would place physicians at increased risk for liability claims.
4. Whether the guidelines impinge upon the psychiatrist duty to warn as established in the Tarasoff court opinion and codified in several statutes and regulations.
We welcome the chance to review these questions with you and others.
Again, many thanks for the opportunity to comment and we look forward to working with you and other stakeholders across the state.
Sincerely yours,
Jeffrey Barkin, M.D.
President, Maine Association of Psychiatric Physicians
References: 1) DHHS/OAMHS: September 2011 Draft Practice Guidelines for Recovery Oriented Care http://www.maine.gov/dhhs/mh/
2) April 2011 APA/AACP analysis of Recovery Oriented Practice: http://www.psych.org/Share/OMNA/Recovery-to-Practice_1/RTP-Situational-Analysis-.aspx?FT=.pdf
3) November 2011 MAPP Comments on Recovery Oriented Care http://www.mainepsych.org/advocacy/Pages/LegislativeIssues.aspx