Boundary Crossings: Systems, Communities, and Expertise

Our theme for this special issue of the American Journal of Psychiatric Rehabilitation is Boundary Crossings, with an eye to systems, communities, and lived and learned expertise of “behavioral health,” which refers to people with mental health and/or addiction challenges. Our theme derives from a 2019 Symposium of the International Recovery & Citizenship Collective (IRCC) at Yale University’s Program for Recovery & Community Health. The IRCC was initiated in 2014 through a collaboration of the Connecticut Department of Mental Health & Addiction Services; the Program for Recovery & Community Health, a research, training, and consultation program of the Yale Department of Psychiatry; and the University of Montreal’s Department of Psychiatry.

The IRCC has grown over the past five years to include policy makers, health care providers, persons with lived experience, advocates, researchers, and other stakeholders from 10 countries— Australia, Brazil, Catalonia/Spain, France, Hong Kong/China, New Zealand, Norway, Quebec/Canada, Scotland, and the United States. The IRCC’s mission is to foster research, policy, service delivery, workforce, and other mental health and addiction innovations that promote recovery, citizenship, and health care system development and transformation. As part of this mission, the IRCC aims to establish global partnerships to promote the development of community-based, peer, paraprofessional, and clinical workforces.

The 2019 IRCC Symposium, Boundary Crossings: Systems, Communities, and Expertise, highlighted ventures and perspectives both outside and within mental health and addiction system interventions and supports. Examples include a massive open online course to bring recovery and citizenship freely to the internet, music making across national borders along with other national boundary crossings to enhance recovery- and citizenship-related partnerships, and the IRCC’s partnership with the International Society for Psychological and Social Approaches to Psychosis, U.S. chapter, on the theme of citizenship in relation to psychosis for the organization’s 2019 conference in New Haven, Connecticut, among other crossings of disciplinary, national, and philosophical boundaries.

Boundary crossings can bring creative people with lived and learned expertise together and open up new perspectives leading to innovation. Boundary crossings can have another face, too: Who gives permission, for example, for a boundary crossing into another’s “space,” or is not asked for permission and can’t refuse? We should think critically about boundary crossings, then, because they are with us today.

For the symposium, we approached the theme of boundary crossings through three major domains: Systems of Care (from traditional clinician-directed care to person-, recovery-, and citizenship-oriented care), Communities and Society (the larger social contexts of the lives of people with mental health and substance use challenges), and Expertise (traditional experts, experts by their lived experience, and those with special perspectives and experiences, such as artists). Presentations, discussions, and site visits covered many topics and programs, including

• • the Connecticut Department of Mental Health & Addiction Services’ systems transformation initiatives to bring together mental, substance use, and primary health care;

• • a social justice collective of persons with and without psychiatric disabilities that advocates for addressing hunger;

• • recovery and citizenship from international perspectives;

• • a community and faith-based recovery initiative for disparities in populations at risk for, or with, opioid use disorders;

• • a theater troupe of persons receiving mental health services that addressed participant concerns such as community reentry following incarceration;

• • adaptation of recovery and citizenship initiatives across borders of countries, languages, and/or cultures;

• • and others.

The call for papers for this special issue focused on the theme of boundary crossings in an attempt to build on the themes and energy generated by the 2019 IRCC Symposium. We have selected eight papers from researchers, persons with lived expertise, and providers of services from five different countries. These papers present new and often bold perspectives on crossing boundaries in relation to mental health, substance use, and other health-related and social conditions, including the need to integrate community and a sense of belonging into people’s recovery, and to employ the citizenship framework to facilitate and support this integration.

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