As the Treatment Advocacy Center States on their website: "Every one of us deserves and benefits from respect, hope, family support, overcoming past trauma and all the other experiences on SAMSHA’s list. However, proposing - among other guidelines - that an "essential, common experience" of recovery is being “person-driven” is uninformed, unrealistic and a grave disservice to the estimated 3.3 million people in America currently living with untreated schizophrenia or severe bipolar disorder.

Individuals with untreated mental illnesses that have psychotic features have, by definition, lost touch with external reality. An estimated half of them don’t even recognize they have a condition from which they need to recover. Large numbers are tragically unable to direct even their own health, hygiene and self-preservation, much less their recovery. A “recovery support” strategy that ignores these clinical realities is discriminatory and blatantly ignores a population that is both entitled to advocacy and uniquely unable to advocate for itself."

Additionally, anosognosia is a critical, relevant, and prevalent feature of both brain disorders and recovery. Those that are afflicted by this lack of insight are especially vulnerable and unable to access these high ideals for recovery, as no acknowledgment of recovery as necessary can be made by people who suffer from anosognosia. This neurological syndrome must be incorporated in to any holistic list of 'principles of recovery' and addressed in any recovery plan.

Additionally, again as TAC states: "Factors like … accurate diagnosis, timely intervention, appropriate treatment, patient education, safe housing are nowhere to be found." True reform in this area of medicine is necessary, and the list above is where we should begin.

The proposed principles of recovery are written at an end of high school to college reading level (using several estimates from readability calculators). Over half of the population reads at or below a 6th grade reading level. Health literacy experts recommend 6th to 8th grade as a desired level for clear and easy to understand written information. The principles should be written for consumers, not for a professional audience. It is often very difficult to explain terms like holistic, person-driven, culturally-based, social network, etc. to many consumers. I have posted a similar concern about the reading level of the definition of recovery.

Recovery is looking to the sky and finding a seagull to guide you to the land. Recovery is
having a drenching rain come down to soak your garment so that you might ring it out to
quench your thirst. Recovery is looking up and seeing a helicopter from the 304 aerospace
rescue squadron vector in on your position. Recovery is putting your body in the sling and
being raised into the ship. Recovery is drinking a big pitcher of water. Recovery is having
a piece of chicken after eating salty seaweed for three weeks. Recovery is standing on land
after drifting at sea for an eternity.

Often I hear people talking about ethnic or language disparities when they use the term cultural competency, and above is a guiding principle that says, "recovery is culturally-based and influenced." But as we move into a new era of Recovery Support Sevices in behavioral health we must start to accept Recovery as a culture into and of itself. Yes there are cultural differences among people in recovery, but the more we focus on their differences, the more we miss out on what unites them as a culture.

So when we begin to employ, train, and implement this brand new recovery support workforce whether or not a person is in recovery (and from what) should be a guiding principle in order to have a culturally competent workforce. It should be valued just as important as their ethnicity and the language they speak.