WAYNESVILLE, N.C. -- Every movement needs a champion, and in the largely rural counties of western North Carolina, Richie Tannerhill is a champion of the recovery-oriented care movement for people with mental health and substance abuse issues.
Recovery-oriented care is founded on the belief that people with behavioral health problems need guideposts to help them find their own routes back to a productive life -- that medication compliance and symptom control aren't ultimate treatment goals.
Advocates of this approach, which involves community-based supports to help people reintegrate into their communities, fear it could be undermined by the omnibus mental health bill sponsored in Congress by Rep. Tim Murphy, a Pennsylvania Republican and clinical child psychologist.
The legislation is now pending in committee and critics say its focus on the needs of those with the most severe, persistent mental illnesses could shortchange many others with more common problems, such as substance abuse and depression, and limit funding for prevention.
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Recovery advocates in North Carolina, where the recovery movement has been gaining momentum, believe such a federal refocus would be a big mistake.
"This movement will be set back decades if the Murphy bill passes," said Sharon Young, co-founder of Full Circle Counseling and Wellness in Hendersonville and a recovery-movement supporter.
Broughton Hospital, a state-run psychiatric facility, shifted to a recovery-oriented approach to care in 2013, and there's been a strong push of late to open peer-run respite centers throughout the state. In addition, the seventh annual One Community in Recovery Conference was held near Winston-Salem in November, drawing recovery-movement advocates from around the country.
Those skeptical of recovery-oriented care argue that its results aren't quantifiable. But Tannerhill and other advocates stress that it's usually part of a broader strategy that includes evidence-based clinical treatment and support services, as recommended by the federal Substance Abuse and Mental Health Services Administration (SAMHSA).
Data collected by the North Carolina Department of Health and Human Services in July 2015 offers evidence that the combination is beginning to show results at Broughton. In the two years after the recovery initiative was launched, the hospital experienced a 16 percent reduction in the use of all types of restrictive interventions.
Peer support is a central element of Broughton's recovery approach and of recovery-oriented care in general. And it's Tannerhill's strength.
He's a trainer of certified peer support specialists for Smoky Mountain, the managed care organization responsible for public funding for mental health, substance abuse and intellectual and developmental disability services for most of mountainous western North Carolina.
Peer-support specialists are counselors who, like Tannerhill, can relate to a person in crisis because they've been down that road. They provide moral support and practical assistance, helping clients find affordable housing, fill out job applications or get to a doctor's appointment.
Tannerhill says he was first arrested in third grade and was regularly using and dealing drugs by age 12. Much of the first three decades of his life was spent in one form of lockup or another. At 31, he was an alcoholic and facing an extended future in the criminal justice system.
But while in prison, he entered a long-term treatment program. That's when he began to embrace the tenants of recovery, and it's the message he now strives to communicate to others.
"You have to do the work," Tannerhill said. "And that work that I do is called recovery."
SAMHSA defines recovery as a "process of change through which individuals improve their health and wellness, live self-directed lives and strive to reach their full potential."
Counselors and peer supporters help a client determine what they want their lives to look like, said Cherene Allen-Caraco, CEO of the Charlotte-based Promise Resource Network, which provides information, training and support to the recovery community.
Tannerhill acknowledges there are many pathways to the threshold of recovery. People may well begin to heal in treatment programs and therapy sessions.
But, he said, "People recover in their communities." He argues they do so more effectively when those communities offer support.
He points to housing as perhaps the most critical need for those in crisis or who are reintegrating into their communities after a stay in an institution. And he is working with advocates from other states with more-established recovery-oriented initiatives in hopes of learning from their experiences.
One such example: Projects to Empower and Organize the Psychiatrically Labeled Inc., or PEOPLe, a not-for-profit peer-run advocacy and crisis-diversion services organization based in Poughkeepsie, N.Y., provides temporary housing for those in need.
CEO Steve Miccio pointed out the program has also reduced hospital recidivism and spending. A stay at one of PEOPLe's homes costs $193 a night; a psychiatric inpatient bed generally runs up to, and sometimes beyond, $1,000 a night.
Last spring, Tannerhill met Phil Valentine, executive director of the Connecticut Community for Addiction Recovery, a former addict and a pioneer in the recovery-oriented care movement.
Valentine, who was hiking the Appalachian Trail to raise awareness of recovery, speaks of overcoming shame, an essential element of recovery.
"Treatment is the initiation of recovery," Valentine explained. "That's when you get that respite to say, 'OK, I've initiated my recovery, I've got that stuff out of my system, the fog is starting to lift ... I'm starting to see that there's hope that I can build a life.'"
Connecticut's recovery-oriented care movement has been going strong for about 15 years, Valentine said. His organization has a staff of 16 and some 400 volunteers. Many of them publicly share their stories of recovery.
Recovery advocates, he said, are acknowledged in Connecticut's health care discussions, including in the state legislature, as voices that "need to be heard."
The voices of recovery, Tannerhill agrees, must be heard in the debate on Capitol Hill concerning mental health and substance abuse issues, and in communities.
"People get well and say, 'I'm done. I don't want to be associated with that anymore.' So we don't get to hear those stories," he said. These are stories that, he believes, are woven into the histories of most every family, stories of navigating home to "normalcy."
(Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.)