Abstract
There has been much written now in the field on recovery-oriented care, its empirical impact, and the need for systems transformation for working with those with serious mental illness across the globe. However, there is still a dearth of that systems level recovery transformation occurring within inpatient settings, as opposed to outpatient, in public mental health and effectively, as the literature reflects. There are even questions of whether it is possible to engage in systems level recovery transformation within inpatient settings that are so structured and set in form, while there is more evidence of recovery transformation systemwide within outpatient services in mental health. This article highlights challenges for recovery-oriented systems change and how inpatient psychiatric settings within public mental health may be experienced, including issues of power and control, violation of basic human rights, racist experiences and overuse of seclusion and restraints for patients with racial minority identities, exacerbation of intersecting oppressive experiences, challenges with civil commitment and conservatorship, arbitrary and inhumane rules, and a strong focus still on diagnosis, medications and symptom amelioration. Despite barriers this article advocates for continuing hope and effort into providing systems level recovery transformation and discusses mechanisms of change in the direction of that transformative process for systems and providers to engage. Such mechanisms include involving senior administration and others throughout systems towards this overall goal and effective manners of collaborative change across disciplines. The article details those skillful systems change strategies in leadership and practical applications to help systems conceptualize how they may make such transformation.