"We are not measured by the trials we meet -- only by those we overcome."
- - Spencer W. Kimball
May 24, 2013
Choice and Accountability: The Second Pillar of Recovery
by Sarah Hancock

Technically speaking, "choice" is the second pillar of psychiatric recovery. Although freedom to choose has long been one of the tenants of our faith -- beginning long before the earth was created -- the general public has a skewed perception of what choice means.

For that reason that I choose to include "accountability" to the second pillar of recovery.

As a young woman, I weekly recited the YW theme. When I was in high school (20 years ago), the theme was changed to seven include values. "Choice and Accountability" made the list. Since then, Virtue made the important cut as well.

Although each value is vital, Choice and Accountability often slides under the social radar. This is especially true when dealing with people who have disabilities. Often we forget that people who have disabilities have their own voice and make choices for them.

For years, this has been true for people with psychiatric illness. Doctors and counselors made "treatment plans" that a person with an illness was supposed to follow, without even consulting the person to find out if he agreed. In fact, since treatment plans involve setting goals, many doctors or counselors set goals their clients weren't interested in achieving.

As the Recovery Model begins to take hold in the psychiatric community, people who have a diagnosis are increasingly participating in creating their own treatment plan. This is vital. If a person isn't interested in their treatment plan, do you think he'll even be motivated to follow it? Nope. Then because he isn't interested in following the treatment plan, he gets labeled "non-compliant," further demoting him in the eyes of his providers.

These days families or other support groups are called into meetings to discuss treatment plans. However, if the client isn't involved in creating the treatment plan and the family is, the person might not have any interest in following the treatment plan.

This results in demoting clients in the eyes of their family or support group. Do you see where I am going here? If the treatment plan seems reasonable to the person with the diagnosis, he or she is more likely to follow the plan, achieving goals. 

Now, let's set aside the plan. Where does accountability come into play? Often people with a mental health diagnosis are given a pass, excusing them from reaping the consequences of their choices. While I am grateful for the many passes I received during the years I really struggled, I can also say that in many instances it didn't help me at all. However, there were times I really needed a pass. 

That being said, I have to clarify something. There is a difference between allowing people to utilize accommodations that enable them to perform at their best and holding them to a moral responsibility.

For example, if I don't fall asleep until 3 am (because my mania has kicked in), jeopardizing my health further by demanding I get up at 6:30 am would be unaccommodating. Even schools and workplaces must provide reasonable accommodations for someone in that situation. However, it is my responsibility to clearly establish those accommodations with my school's disability office or Human Resources department before I begin work or school. So long as they don't alter the essential functions of the job or the academic program in which I'm enrolled, I can utilize those accommodations.

On the other hand, let's suppose I'm manic and driving. When you drive manic it feels like everyone else is parked. Obviously I'm going to move around parked vehicles. Mentally, due to my whacked out chemicals, I will feel like I am driving about 45 when I'm really hauling down the freeway at 100 mph, weaving in and out of traffic.

I still need to be held accountable for my actions, regardless of whether or not they were caused by my illness. Perhaps instead of paying a huge fine, the judge will accept a letter from my doctor explaining I was symptomatic and allow me to do 100 hours of community service.

Either way, I am held responsible for my actions. In the meanwhile I am able to pay for my consequences, learn from them and apply that learning to other things in my life. If someone intervened, paid the hefty fine and let me drive off on my merry way, would I learn anything? Nope. How much more likely would I be to fall into the same behavior pattern later? Very likely!   

Often people don't allow people with mental illness to make their own decisions in an effort to protect them from failure. For example, maybe a parent thinks, "I'm not going to allow my son to apply for college, because I know it will stress him out and he'll get sick."

Although this parent is well intended, not allowing the son to try something is further crippling the son. What will he learn from failure? What holds him back from success later? Regardless of what you are trying to protect your loved one or person you serve from, you are crippling him in the process.

You must remember, there is dignity in failure. Besides, it's only a failure if the person doesn't learn how to pick himself up, brush himself off and try it again.

The most important thing to remember is the reaction a family member, service provider, friend, acquaintance or church leader has to a perceived "failure" will ultimately determine if eventually the a person with a diagnosis sinks into a hole of failure or finds the strength within to propels himself forward.  

In my recovery journey, I made very, very slow progress in the beginning. I believe that a part of the reason my recovery began so slowly was because I didn't really have a choice in my plan. Many people just kept telling me what I was capable of doing relying on the prognosis of my diagnosis. After you hear your prognosis again and again, you begin to think, "Why try?"

Gratefully I was able to move past the "why try" phase when I began to see that my efforts (both positive and negative) resulting in situations I began to believe I had control over. Regardless of how much control. First it was small (i.e. I can wash my hair with a shampoo I like and blend in with society vs. I can leave my hair dirty and have people make disgusted faces at me and avoid me).

Then it was big (i.e. I can move out of this horrific group home and risk failure or I can move out of this horrific group home and risk success). Ultimately I realized I had a choice (whether or not people supported me) and I needed to hold myself accountable for the outcome. I realized I couldn't complain if I wasn't doing anything to change the situation.

It wasn't that I was previously not trying to change, the difference came when I believed that my efforts were not in vain. Suddenly, I felt empowered to actually change.

Empowerment, the third pillar of Recovery will be discussed next time. In the meanwhile, think about the choices to be made and their consequences. It makes for a lively round of mental gymnastics!

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About Sarah Hancock

Sarah Price Hancock, a graduate of San Diego State University's rehabilitation counseling Masters of Science program with a certificate psychiatric rehabilitation.

Having embarked on her own journey with a mental health diagnosis, she is passionate about psychiatric recovery. She enjoys working as a lector for universities, training upcoming mental health professionals. Sarah also enjoys sharing insights with peers working to strengthen their "recovery toolbox." With proper support, Sarah knows psychiatric recovery isn’t just possible — it’s probable.

Born and raised in San Diego, California, Sarah served a Spanish-speaking and ASL mission for the LDS Church in the Texas Dallas Mission. She was graduated from Ricks College and BYU. Sarah currently resides in San Diego and inherited four amazing children when she married the man of her dreams in 2011. She loves writing, public speaking, ceramics, jewelry-making and kite-flying — not necessarily in that order.

NAMI San Diego's Fall Keynote Address: Living in Recovery with Schizoaffective Disorder

Having recently moved into a new ward, she currently serves as a visiting teacher.

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