Changing perspectives for TR in mental health services.

Doing more with less has become an unfortunate anthem for providers of mental health services. The "more" includes producing documentable outcomes and contributing to helping the client gain the best possible quality of life. "More" also means providing a greater range of services. "Less" means that these positive outcomes are expected to be achieved in less time and money. Less restrictive treatment is emphasized with a goal of minimizing separation from regular life roles and responsibilities.

Doing less with more requires new perspectives on therapeutic recreation. And new ways of thinking and doing have resulted in innovative ideas and programs.

The Hardiness Frame of Reference

Suzanne Oullette describes "hardiness" as a collection of personal characteristics that allow individuals to cope with and not get sick from stress. Components of hardiness include commitment, control, and challenge. Each is relevant to individuals who are restoring and reawakening their mental health.

Commitment is the opposite of apathy. It suggests dedication to people and ideas which transcend ones self. Examples include religious faith, loyalty to groups/teams/organizations, dedication to values and ideals, zeal for relationships, and enthusiasm for vocation or avocation. Commitment means caring.

Control relates to empowerment. It is the opposite of helplessness and hopelessness. As control increases, investment and engagement in activities can increase. With a sense of control comes the realization that while much cannot be solved, much can be resolved. Control means power and acceptance of responsibility.

Challenge refers to a positive perspective on change - viewing new experience not as a threat but rather as an opportunity. Challenge also relates to an appropriate balance of tasks with skills. Challenge creates confidence.

Therapeutic recreation services can be relevant to the development of "hardiness" as Figure 1 suggests. And program process and content can be designed to foster enhanced resilience and wellness.

Practitioner Competence

As service delivery changes, the competencies needed to provide effective services also change. The singular role of leisure educator or recreation experience provider give way to the diverse roles of "brief therapist". These roles are detailed in Figure 2. While the categories or rubrics which describe our responsibilities may remain the same, these terms will have very different meanings down the road. For example, in the past, assessment in many mental health settings referred to doing a leisure interest finder with a client or perhaps identifying significant barriers to greater recreation participation. Today, assessment more often would include involvement in a multidisciplinary functional assessment of programs and strengths, provision of diagnostic activity experiences, and identification of client/patient's knowledge of and ability to access community resources.

As roles become more diverse, the need for broader education and training is important to effectiveness and continued employability. Practitioners in therapeutic recreation need to develop their skills with specific activity media further (e.g., relaxation training, communication skill development, or adventure programming) and consider cross - training in relevant program areas such as certification in addictions counseling. Similarly, they need to develop and or become a part of systems for peer review and clinical supervision which allow for interaction with and feedback from professionals beyond just other therapeutic recreation specialists.

A Final Thought

Physical and mental illness in our society continue to be interpreted and responded to in divergent ways. While physical illness often warrants understanding and empathy, responses to mental illness too often include scorn and disbelief Examples include:

* The person with depression is told to Just snap out of it."

* The person with multiple personality disorder is faced with family and/or employer skepticism.

* The alcoholic is treated as a criminal rather than as having an illness.

Helpers, including recreation professionals, who adopt a "hardiness" building approach and develop new competence as "brief therapists" will be better prepared and will better prepare those they serve in debunking these and other stereotypes.

The changing spectrum of mental health services can provide opportunities for emerging professions like therapeutic recreation to become more included and integrated in treatment protocols and programs. Our personal and collective "hardiness" as therapeutic recreation specialists may be well determined by the extent to which we recognize changing perspectives in mental health and demonstrate the new competencies and attitudes necessary to cope with change.