Recovery model
Encyclopedia
The Recovery Model as it applies to mental health is an approach to mental disorder or substance dependence
(and/or from being labeled
in those terms) that emphasizes and supports each individual's potential for recovery. Recovery is seen within the model as a personal journey
, that may involve developing hope
, a secure base and sense of self, supportive relationships
, empowerment
, social inclusion, coping skills, and meaning
. Originating from the 12-Step Program of Alcoholics Anonymous
and the Civil Rights Movement
, the use of the concept in mental health emerged as deinstitutionalization resulted in more individuals living in the community. It gained impetus due to a perceived failure by services or wider society to adequately support social inclusion, and by studies demonstrating that many can recover. The Recovery Model has now been explicitly adopted as the guiding principle of the mental health systems of a number of countries and states. In many cases practical steps are being taken to base services on the recovery model, although there are a variety of obstacles and concerns raised. A number of standardized measures have been developed to assess aspects of recovery, although there is some variation between professionalized models and those originating in the Psychiatric survivors movement
.
and psychiatry
, recovery has long been used to refer to the end of a particular experience or episode of illness
. The broader concept of "recovery" as a general philosophy and model was first popularized in regard to recovery from substance abuse
/drug addiction, for example within twelve-step program
s.
Application of recovery model concepts to psychiatric disorders is comparatively recent. By consensus the main impetus for the development came from the Consumer/Survivor/Ex-Patient Movement, a grassroots self-help and advocacy initiative, particularly within the United States
during the late 1980s and early 1990s. The professional literature, starting with the psychiatric rehabilitation
movement in particular, began to incorporate the concept from the early 1990s in the United States, followed by New Zealand and more recently across nearly all countries within the "First World
". Similar approaches developed around the same time, without necessarily using the term recovery, in Italy, the Netherlands and the UK. Developments were fueled by a number of long term outcome studies of people with "major mental illnesses" in populations from virtually every continent, including landmark crossnational studies by the World Health Organization
from the 1970s and 1990s, showing unexpectedly high rates of complete or partial recovery, with exact statistics varying by region and the criteria used. The cumulative impact of personal stories or testimony
of recovery has also been a powerful force behind the development of recovery approaches and policies. A key issue became how service consumers could maintain the ownership and authenticity of recovery concepts while also supporting them in professional policy and practice.
Increasingly, recovery became both a subject of mental health services research and a term emblematic of many of the goals of the Consumer/Survivor/Ex-Patient Movement. The concept of recovery was often defined and applied differently by consumers/survivors and professionals. Specific policy and clinical strategies were developed to implement recovery principles although key questions remained.
, empowerment and real-world personal experience. Recovery can be seen in terms of a social model of disability
rather than a medical model of disability
, and there may be differences in the degree of acceptance of diagnostic "labels" and treatments. In psychiatric rehabilitation, the concept of recovery may be used to refer primarily to managing symptoms, reducing psychosocial disability, and improving role performance. A review of the psychiatric literature suggested authors are rarely explicit about which concept they are employing; the reviewers called "rehabilitation" perspectives those which focused on life and meaning within the context of supposedly enduring disability, and "clinical" those which focused on observable remission of symptoms and restoration of functioning.
A consensus statement on mental health recovery from US agencies, that involved some consumer input, defined recovery as a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential. Ten fundamental components were elucidated, all assuming that the person continues to be a "consumer" or to have a "mental disability". Conferences have been held on the importance of the "elusive" concept from the perspectives of consumers and psychiatrists.
From the perspective of psychiatric rehabilitation services, a number of qualities of recovery have been suggested: recovery can occur without professional intervention; recovery requires people who believe in and stand by the person in recovery; a recovery vision is not a function of theories about the cause of psychiatric conditions; recovery can occur even if symptoms reoccur; recovery changes the frequency and duration of symptoms; recovery from the consequences of a psychiatric condition are often far more difficult than from the symptoms; recovery is not linear
; recovery takes place as a series of small steps; recovery does not mean the person was never really psychiatrically disabled; recovery focuses on wellness not illness; recovery should focus on consumer choice.
An approach to recovery known as the Tidal Model
focuses on the continuous process of change inherent in all people, conveying the meaning of the experiences through water metaphor
s. Crisis
is seen as involving opportunity, creativity
is valued, and different domains are explored such as a person's sense of security, their personal narrative
and their relationships. Initially developed by mental health nurses
along with service users, Tidal is one of the few recovery models to have been researched rigorously. The Tidal Model is based on a discrete set of values (the Ten Commitments) and emphasizes the importance of each person's own voice, resourcefulness and wisdom. Since 1999, projects based on the Tidal Model have been established in the USA, Canada, Japan, New Zealand, Australia, Republic of Ireland, Scotland, Wales and England, where Tidal was originally developed. The Tidal Model has been used with a wide range of populations and is, arguably, the most widely used model of recovery.
For many, "recovery" has a political as well as personal implication—where to recover is to find meaning, to challenge prejudice (including diagnostic "labels" in some cases), perhaps to be a "bad" non-compliant patient and refuse to accept the indoctrination of the system, to reclaim a chosen life and place within society, and to validate the self. Recovery can thus be viewed as one manifestation of empowerment. An empowerment model of recovery may emphasize that conditions are not necessarily permanent, that other people have recovered who can be role models and share experiences, and "symptoms" can be understood as expressions of distress related to emotions and other people. One such model from the US National Empowerment Center
proposes a number of principles of how people recover and identifies the characteristics of people in recovery.
Recovery may be seen as more of a philosophy or attitude than a specific model, requiring that "we regain personal power and a valued place in our communities. Sometimes we need services to support us to get there".
.
The New Freedom Commission's emphasis on the recovery model has been interpreted by some critics as saying that everyone can fully recover through sheer will power, and therefore as giving false hope to those judged unable to recover and implicitly blaming those people judged unable to recover. However, the critics have themselves been charged with undermining consumer rights and failing to recognize that the model is intended to support a person in their personal journey rather than expecting a given outcome, and that it relates to social and political support and empowerment as well as the individual. Other criticisms include that the recovery model can be manipulated by officials to serve various political and financial interests including withdrawing services and pushing people out before they're ready; that it is becoming a new orthodoxy
or bandwagon that neglects the empowerment aspects and structural problems of societies and primarily represents a middle class experience; that it hides the continued dominance of a medical model; and that it potentially increases social exclusion and marginalizes those who don't fit into a recovery narrative.
Various stages of resistance to recovery approaches have been identified amongst staff in traditional services, starting with "Our people [first of all, they aren't 'your people'] are much sicker than yours. They won't be able to recover" and ending in "Our doctors will never agree to this"—but ways to harness the energy of resistance and use it to move forward have been proposed. Staff training materials have been developed, for example by the National Empowerment Center.
(and to some extent any system of categorical classification of mental disorders
) uses criteria, definitions and terminology that are inconsistent with a recovery model, and therefore does not promote a culture in which people can improve and recover. It has been suggested that the DSM-V requires greater sensitivity to cultural issues and gender; needs to recognize the need for others to change as well as just those singled out for a diagnosis of disorder; and that it needs to adopt a dimensional approach to assessment that better captures individuality and does not erroneously imply excess psychopathology or chronicity.
A number of standardized questionnaires and assessments have been developed to try to assess aspects of the recovery journey. These include the Milestones of Recovery (MOR) Scale, Recovery Enhancing Environment (REE) measure, the Recovery Measurement Tool (RMT) and the Recovery Oriented System Indicators (ROSI) Measure, the Stages of Recovery Instrument (STORI), and numerous related instruments.
but a sustainable belief in oneself and a willingness to persevere through uncertainty and setbacks. Hope may start at a certain turning point, or emerge gradually as a small and fragile feeling, and may fluctuate with despair. It is said to involve trusting, and risking disappointment
, failure
and further hurt
.
, a sufficient income
, freedom from violence
, and adequate access to health care
have also been proposed. It has been suggested that home is where recovery may begin but that housing services and the "continuum of care concept" have failed to flexibly involve people and build on their personal visions and strengths, instead "placing" and "reinstitutionalizing" them.
, etc. It was suggested that the process is usually greatly facilitated by experiences of interpersonal acceptance
, mutuality, and a sense of social belonging; and is often challenging in the face of the typical barrage of overt and covert negative messages that come from the broader social context.
s can offer a particular limited kind of relationship and help foster hope, relationships with friends
, family
and the community
are said to often be of wider and longer-term importance. Others who have experienced similar difficulties, who may be on a journey of recovery, can be of particular importance. Those who share the same values and outlooks more generally (not just in the area of mental health) may also be particularly important. It is said that one-way relationships based on being helped can actually be devaluing, and that reciprocal
relationships and mutual support networks can be of more value to self-esteem
and recovery.
are said to be important to recovery, including having self control
. This can mean developing the confidence
for independent assertive decision making
and help-seeking. Achieving social inclusion may require support and may require challenging stigma
and prejudice
about mental distress/disorder/difference. It may also require recovering unpracticed social skills or making up for gaps in work history.
(including self-management
or self-help
) is said to be an important element. This can involve making use of medication
or psychotherapy
if the consumer is fully informed
and listened
to, including about adverse effect
s and about which methods fit with the consumer's life and their journey of recovery. Developing coping and problem solving
skills to manage individual traits and problem issues (which may or may not be seen as symptom
s of mental disorder) may require a person becoming their own expert, in order to identify key stress
points and possible crisis points, and to understand and develop personal ways of responding and coping.
Being able to move on can mean having to cope with feelings of loss
, which may include despair and anger
. When an individual is ready, this can mean a process of grieving. It may require accepting past suffering
and lost opportunities or lost time
.
, religion
, politics
or culture
. From a postmodern perspective, this can be seen as developing a narrative.
of care from traditional medical psychiatric treatment toward the concept of recovery, and the American Psychiatric Association
has endorsed a recovery model from a psychiatric services perspective.
The US Department of Health and Human Services reports developing national and state initiatives to empower consumers and support recovery, with specific committees planning to launch nationwide pro-recovery, anti-stigma education campaigns; develop and synthesize recovery policies; train consumers in carrying out evaluations of mental health systems; and help further the development of peer-run services. Mental Health service directors and planners are providing guidance to help state services implement recovery approaches.
Some US states, such as California
(see the California Mental Health Services Act
), Wisconsin
and Ohio
, already report redesigning their mental health systems to stress recovery model values like hope, healing, empowerment, social connectedness, human rights, and recovery-oriented services.
At least some parts of the Canadian Mental Health Association
, such as the Ontario
region, have adopted recovery as a guiding principle for reforming and developing the mental health system.
have been required by government policy to use a recovery approach and mental health professionals are expected to demonstrate competence in the recovery model. Australia
's National Mental Health Plan 2003-2008 states that services should adopt a recovery orientation although there is variation between Australian states and territories in the level of knowledge, commitment and implementation.
(NIMHE) endorsed a recovery model as a possible guiding principle of mental health service provision and public education. The National Health Service
is implementing a recovery approach in at least some regions, and has developed a new professional role of Support Time and Recovery Worker. A leading independent charity issued a 2008 policy paper proposing that the recovery approach is an idea "whose time has come". The Scottish Executive
has included the promotion and support of recovery as one of its four key mental health aims and funded a Scottish Recovery Network
to facilitate this. A 2006 review of nursing in Scotland recommended a recovery approach as the model for mental health nursing care and intervention. The Mental Health Commission of Ireland
reports that its guiding documents place the service user at the core and emphasize an individual's personal journey towards recovery.
Substance dependence
The section about substance dependence in the Diagnostic and Statistical Manual of Mental Disorders does not use the word addiction at all. It explains:...
(and/or from being labeled
Labeling theory
Labeling theory is closely related to interactionist and social construction theories. Labeling theory was developed by sociologists during the 1960's. Howard Saul Becker's book entitled Outsiders was extremely influential in the development of this theory and its rise to popularity...
in those terms) that emphasizes and supports each individual's potential for recovery. Recovery is seen within the model as a personal journey
Quest
In mythology and literature, a quest, a journey towards a goal, serves as a plot device and as a symbol. Quests appear in the folklore of every nation and also figure prominently in non-national cultures. In literature, the objects of quests require great exertion on the part of the hero, and...
, that may involve developing hope
Hope
Hope is the emotional state which promotes the belief in a positive outcome related to events and circumstances in one's life. It is the "feeling that what is wanted can be had or that events will turn out for the best" or the act of "look[ing] forward to with desire and reasonable confidence" or...
, a secure base and sense of self, supportive relationships
Interpersonal relationship
An interpersonal relationship is an association between two or more people that may range from fleeting to enduring. This association may be based on limerence, love, solidarity, regular business interactions, or some other type of social commitment. Interpersonal relationships are formed in the...
, empowerment
Empowerment
Empowerment refers to increasing the spiritual, political, social, racial, educational, gender or economic strength of individuals and communities...
, social inclusion, coping skills, and meaning
Value (personal and cultural)
A personal or cultural value is an absolute or relative ethical value, the assumption of which can be the basis for ethical action. A value system is a set of consistent values and measures. A principle value is a foundation upon which other values and measures of integrity are based...
. Originating from the 12-Step Program of Alcoholics Anonymous
Alcoholics Anonymous
Alcoholics Anonymous is an international mutual aid movement which says its "primary purpose is to stay sober and help other alcoholics achieve sobriety." Now claiming more than 2 million members, AA was founded in 1935 by Bill Wilson and Dr. Bob Smith in Akron, Ohio...
and the Civil Rights Movement
Civil rights movement
The civil rights movement was a worldwide political movement for equality before the law occurring between approximately 1950 and 1980. In many situations it took the form of campaigns of civil resistance aimed at achieving change by nonviolent forms of resistance. In some situations it was...
, the use of the concept in mental health emerged as deinstitutionalization resulted in more individuals living in the community. It gained impetus due to a perceived failure by services or wider society to adequately support social inclusion, and by studies demonstrating that many can recover. The Recovery Model has now been explicitly adopted as the guiding principle of the mental health systems of a number of countries and states. In many cases practical steps are being taken to base services on the recovery model, although there are a variety of obstacles and concerns raised. A number of standardized measures have been developed to assess aspects of recovery, although there is some variation between professionalized models and those originating in the Psychiatric survivors movement
Psychiatric survivors movement
The psychiatric survivors movement is a diverse association of individuals who are either currently clients of mental health services , or who consider themselves survivors of interventions by psychiatry, or who identify themselves as ex-patients of mental health services...
.
History
In general medicineMedicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
and psychiatry
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
, recovery has long been used to refer to the end of a particular experience or episode of illness
Illness
Illness is a state of poor health. Illness is sometimes considered another word for disease. Others maintain that fine distinctions exist...
. The broader concept of "recovery" as a general philosophy and model was first popularized in regard to recovery from substance abuse
Substance abuse
A substance-related disorder is an umbrella term used to describe several different conditions associated with several different substances .A substance related disorder is a condition in which an individual uses or abuses a...
/drug addiction, for example within twelve-step program
Twelve-step program
A Twelve-Step Program is a set of guiding principles outlining a course of action for recovery from addiction, compulsion, or other behavioral problems...
s.
Application of recovery model concepts to psychiatric disorders is comparatively recent. By consensus the main impetus for the development came from the Consumer/Survivor/Ex-Patient Movement, a grassroots self-help and advocacy initiative, particularly within the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
during the late 1980s and early 1990s. The professional literature, starting with the psychiatric rehabilitation
Psychiatric rehabilitation
Psychiatric rehabilitation, also known as psychosocial rehabilitation, and usually simplified to psych rehab, is the process of restoration of community functioning and well-being of an individual who has a psychiatric disability...
movement in particular, began to incorporate the concept from the early 1990s in the United States, followed by New Zealand and more recently across nearly all countries within the "First World
First World
The concept of the First World first originated during the Cold War, where it was used to describe countries that were aligned with the United States. These countries were democratic and capitalistic. After the fall of the Soviet Union and the end of the Cold War, the term "First World" took on a...
". Similar approaches developed around the same time, without necessarily using the term recovery, in Italy, the Netherlands and the UK. Developments were fueled by a number of long term outcome studies of people with "major mental illnesses" in populations from virtually every continent, including landmark crossnational studies by the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
from the 1970s and 1990s, showing unexpectedly high rates of complete or partial recovery, with exact statistics varying by region and the criteria used. The cumulative impact of personal stories or testimony
Testimony
In law and in religion, testimony is a solemn attestation as to the truth of a matter. All testimonies should be well thought out and truthful. It was the custom in Ancient Rome for the men to place their right hand on a Bible when taking an oath...
of recovery has also been a powerful force behind the development of recovery approaches and policies. A key issue became how service consumers could maintain the ownership and authenticity of recovery concepts while also supporting them in professional policy and practice.
Increasingly, recovery became both a subject of mental health services research and a term emblematic of many of the goals of the Consumer/Survivor/Ex-Patient Movement. The concept of recovery was often defined and applied differently by consumers/survivors and professionals. Specific policy and clinical strategies were developed to implement recovery principles although key questions remained.
Variation
There is some variation in how recovery is conceptualized within models. Professionalized clinical approaches tend to focus on improvement, in particular symptoms and functions, and on the role of treatments; consumer/survivor models tend to put more emphasis on peer supportPeer support
Peer support occurs when people provide knowledge, experience, emotional, social or practical help to each other. It commonly refers to an initiative consisting of trained supporters, and can take a number of forms such as peer mentoring, listening, or counseling...
, empowerment and real-world personal experience. Recovery can be seen in terms of a social model of disability
Social model of disability
The social model of disability is a reaction to the dominant medical model of disability which in itself is a Cartesian functional analysis of the body as machine to be fixed in order to conform with normative values...
rather than a medical model of disability
Disability
A disability may be physical, cognitive, mental, sensory, emotional, developmental or some combination of these.Many people would rather be referred to as a person with a disability instead of handicapped...
, and there may be differences in the degree of acceptance of diagnostic "labels" and treatments. In psychiatric rehabilitation, the concept of recovery may be used to refer primarily to managing symptoms, reducing psychosocial disability, and improving role performance. A review of the psychiatric literature suggested authors are rarely explicit about which concept they are employing; the reviewers called "rehabilitation" perspectives those which focused on life and meaning within the context of supposedly enduring disability, and "clinical" those which focused on observable remission of symptoms and restoration of functioning.
A consensus statement on mental health recovery from US agencies, that involved some consumer input, defined recovery as a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential. Ten fundamental components were elucidated, all assuming that the person continues to be a "consumer" or to have a "mental disability". Conferences have been held on the importance of the "elusive" concept from the perspectives of consumers and psychiatrists.
From the perspective of psychiatric rehabilitation services, a number of qualities of recovery have been suggested: recovery can occur without professional intervention; recovery requires people who believe in and stand by the person in recovery; a recovery vision is not a function of theories about the cause of psychiatric conditions; recovery can occur even if symptoms reoccur; recovery changes the frequency and duration of symptoms; recovery from the consequences of a psychiatric condition are often far more difficult than from the symptoms; recovery is not linear
Linear
In mathematics, a linear map or function f is a function which satisfies the following two properties:* Additivity : f = f + f...
; recovery takes place as a series of small steps; recovery does not mean the person was never really psychiatrically disabled; recovery focuses on wellness not illness; recovery should focus on consumer choice.
An approach to recovery known as the Tidal Model
Tidal Model
The Tidal Model is a recovery model for the promotion of mental health developed by Professor Phil Barker, Poppy Buchanan-Barker and their colleagues. The Tidal Model focuses on the continuous process of change inherent in all people. It seeks to reveal the meaning of people's experiences,...
focuses on the continuous process of change inherent in all people, conveying the meaning of the experiences through water metaphor
Metaphor
A metaphor is a literary figure of speech that uses an image, story or tangible thing to represent a less tangible thing or some intangible quality or idea; e.g., "Her eyes were glistening jewels." Metaphor may also be used for any rhetorical figures of speech that achieve their effects via...
s. Crisis
Crisis
A crisis is any event that is, or expected to lead to, an unstable and dangerous situation affecting an individual, group, community or whole society...
is seen as involving opportunity, creativity
Creativity
Creativity refers to the phenomenon whereby a person creates something new that has some kind of value. What counts as "new" may be in reference to the individual creator, or to the society or domain within which the novelty occurs...
is valued, and different domains are explored such as a person's sense of security, their personal narrative
Narrative
A narrative is a constructive format that describes a sequence of non-fictional or fictional events. The word derives from the Latin verb narrare, "to recount", and is related to the adjective gnarus, "knowing" or "skilled"...
and their relationships. Initially developed by mental health nurses
Psychiatric and mental health nursing
Psychiatric nursing or mental health nursing is the specialty of nursing that cares for people of all ages with mental illness or mental distress, such as schizophrenia, bipolar disorder, psychosis, depression or dementia...
along with service users, Tidal is one of the few recovery models to have been researched rigorously. The Tidal Model is based on a discrete set of values (the Ten Commitments) and emphasizes the importance of each person's own voice, resourcefulness and wisdom. Since 1999, projects based on the Tidal Model have been established in the USA, Canada, Japan, New Zealand, Australia, Republic of Ireland, Scotland, Wales and England, where Tidal was originally developed. The Tidal Model has been used with a wide range of populations and is, arguably, the most widely used model of recovery.
For many, "recovery" has a political as well as personal implication—where to recover is to find meaning, to challenge prejudice (including diagnostic "labels" in some cases), perhaps to be a "bad" non-compliant patient and refuse to accept the indoctrination of the system, to reclaim a chosen life and place within society, and to validate the self. Recovery can thus be viewed as one manifestation of empowerment. An empowerment model of recovery may emphasize that conditions are not necessarily permanent, that other people have recovered who can be role models and share experiences, and "symptoms" can be understood as expressions of distress related to emotions and other people. One such model from the US National Empowerment Center
National Empowerment Center
The National Empowerment Center is an advocacy and peer-support organization in the United States that promotes an empowerment-based recovery model of mental disorder. It is run by consumers/survivors/ex-patients in recovery....
proposes a number of principles of how people recover and identifies the characteristics of people in recovery.
Recovery may be seen as more of a philosophy or attitude than a specific model, requiring that "we regain personal power and a valued place in our communities. Sometimes we need services to support us to get there".
Concerns
Some concerns have been raised about recovery models, including that recovery is an old concept, that a focus on recovery adds to the burden of already stretched providers, that recovery must involve cure, that recovery happens to very few people, that recovery represents an irresponsible fad, that recovery happens only after and as a result of active treatment, that recovery-oriented care can only be implemented through the addition of new resources, that recovery-oriented care is neither reimbursable nor evidence based, that recovery-oriented care devalues the role of professional intervention, and that recovery-oriented care increases providers' exposure to risk and liability. There have also been tensions between recovery models and particular "evidence-based practice" models in the transformation of US mental health services based on the recommendations of the New Freedom Commission on Mental HealthNew Freedom Commission on Mental Health
The controversial New Freedom Commission on Mental Health was established by U.S. President George W. Bush in April 2002 to conduct a comprehensive study of the U.S. mental health service delivery system and make recommendations based on its findings...
.
The New Freedom Commission's emphasis on the recovery model has been interpreted by some critics as saying that everyone can fully recover through sheer will power, and therefore as giving false hope to those judged unable to recover and implicitly blaming those people judged unable to recover. However, the critics have themselves been charged with undermining consumer rights and failing to recognize that the model is intended to support a person in their personal journey rather than expecting a given outcome, and that it relates to social and political support and empowerment as well as the individual. Other criticisms include that the recovery model can be manipulated by officials to serve various political and financial interests including withdrawing services and pushing people out before they're ready; that it is becoming a new orthodoxy
Orthodoxy
The word orthodox, from Greek orthos + doxa , is generally used to mean the adherence to accepted norms, more specifically to creeds, especially in religion...
or bandwagon that neglects the empowerment aspects and structural problems of societies and primarily represents a middle class experience; that it hides the continued dominance of a medical model; and that it potentially increases social exclusion and marginalizes those who don't fit into a recovery narrative.
Various stages of resistance to recovery approaches have been identified amongst staff in traditional services, starting with "Our people [first of all, they aren't 'your people'] are much sicker than yours. They won't be able to recover" and ending in "Our doctors will never agree to this"—but ways to harness the energy of resistance and use it to move forward have been proposed. Staff training materials have been developed, for example by the National Empowerment Center.
Assessments
The data-collection systems and terminology used by services and funders are typically incompatible with recovery frameworks, so methods of adapting IT resources or paper forms have been developed. It has also been pointed out that the Diagnostic and Statistical Manual of Mental DisordersDiagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...
(and to some extent any system of categorical classification of mental disorders
Classification of mental disorders
The classification of mental disorders, also known as psychiatric nosology or taxonomy, is a key aspect of psychiatry and other mental health professions and an important issue for consumers and providers of mental health services...
) uses criteria, definitions and terminology that are inconsistent with a recovery model, and therefore does not promote a culture in which people can improve and recover. It has been suggested that the DSM-V requires greater sensitivity to cultural issues and gender; needs to recognize the need for others to change as well as just those singled out for a diagnosis of disorder; and that it needs to adopt a dimensional approach to assessment that better captures individuality and does not erroneously imply excess psychopathology or chronicity.
A number of standardized questionnaires and assessments have been developed to try to assess aspects of the recovery journey. These include the Milestones of Recovery (MOR) Scale, Recovery Enhancing Environment (REE) measure, the Recovery Measurement Tool (RMT) and the Recovery Oriented System Indicators (ROSI) Measure, the Stages of Recovery Instrument (STORI), and numerous related instruments.
Elements of recovery
It has been emphasized that each individual's journey to recovery is a deeply personal process, as well as being related to an individual's community and society. A number of features have been proposed as often being core elements, however:Hope
Finding and nurturing hope has been described as a key to recovery. It is said to include not just optimismOptimism
The Oxford English Dictionary defines optimism as having "hopefulness and confidence about the future or successful outcome of something; a tendency to take a favourable or hopeful view." The word is originally derived from the Latin optimum, meaning "best." Being optimistic, in the typical sense...
but a sustainable belief in oneself and a willingness to persevere through uncertainty and setbacks. Hope may start at a certain turning point, or emerge gradually as a small and fragile feeling, and may fluctuate with despair. It is said to involve trusting, and risking disappointment
Disappointment
Disappointment is the feeling of dissatisfaction that follows the failure of expectations or hopes to manifest. Similar to regret, it differs in that a person feeling regret focuses primarily on the personal choices that contributed to a poor outcome, while a person feeling disappointment focuses...
, failure
Failure
Failure refers to the state or condition of not meeting a desirable or intended objective, and may be viewed as the opposite of success. Product failure ranges from failure to sell the product to fracture of the product, in the worst cases leading to personal injury, the province of forensic...
and further hurt
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
.
Secure base
Appropriate housingHouse
A house is a building or structure that has the ability to be occupied for dwelling by human beings or other creatures. The term house includes many kinds of different dwellings ranging from rudimentary huts of nomadic tribes to free standing individual structures...
, a sufficient income
Income
Income is the consumption and savings opportunity gained by an entity within a specified time frame, which is generally expressed in monetary terms. However, for households and individuals, "income is the sum of all the wages, salaries, profits, interests payments, rents and other forms of earnings...
, freedom from violence
Violence
Violence is the use of physical force to apply a state to others contrary to their wishes. violence, while often a stand-alone issue, is often the culmination of other kinds of conflict, e.g...
, and adequate access to health care
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
have also been proposed. It has been suggested that home is where recovery may begin but that housing services and the "continuum of care concept" have failed to flexibly involve people and build on their personal visions and strengths, instead "placing" and "reinstitutionalizing" them.
Self
Recovery of a durable sense of self (if it had been lost or taken away) has been proposed as an important element. A research review suggested that people sometimes achieve this by "positive withdrawal"—regulating social involvement and negotiating public space in order to only move towards others in a way that feels safe yet meaningful; and nurturing personal psychological space that allows room for developing understanding and a broad sense of self, interests, spiritualitySpirituality
Spirituality can refer to an ultimate or an alleged immaterial reality; an inner path enabling a person to discover the essence of his/her being; or the “deepest values and meanings by which people live.” Spiritual practices, including meditation, prayer and contemplation, are intended to develop...
, etc. It was suggested that the process is usually greatly facilitated by experiences of interpersonal acceptance
Acceptance
Acceptance is a person's agreement to experience a situation, to follow a process or condition without attempting to change it, protest, or exit....
, mutuality, and a sense of social belonging; and is often challenging in the face of the typical barrage of overt and covert negative messages that come from the broader social context.
Supportive relationships
A common aspect of recovery is said to be the presence of others who believe in the person's potential to recover, and who stand by them. While mental health professionalMental health professional
A mental health professional is a health care practitioner who offers services for the purpose of improving an individual's mental health or to treat mental illness. This broad category includes psychiatrists, clinical psychologists, clinical social workers, psychiatric nurses, mental health...
s can offer a particular limited kind of relationship and help foster hope, relationships with friends
Friends
Friends is an American sitcom created by David Crane and Marta Kauffman, which aired on NBC from September 22, 1994 to May 6, 2004. The series revolves around a group of friends in Manhattan. The series was produced by Bright/Kauffman/Crane Productions, in association with Warner Bros. Television...
, family
Family
In human context, a family is a group of people affiliated by consanguinity, affinity, or co-residence. In most societies it is the principal institution for the socialization of children...
and the community
Community
The term community has two distinct meanings:*a group of interacting people, possibly living in close proximity, and often refers to a group that shares some common values, and is attributed with social cohesion within a shared geographical location, generally in social units larger than a household...
are said to often be of wider and longer-term importance. Others who have experienced similar difficulties, who may be on a journey of recovery, can be of particular importance. Those who share the same values and outlooks more generally (not just in the area of mental health) may also be particularly important. It is said that one-way relationships based on being helped can actually be devaluing, and that reciprocal
Reciprocity (social psychology)
Reciprocity in social psychology refers to responding to a positive action with another positive action, rewarding kind actions. People categorize an action as kind by viewing its consequences and also by the person's fundamental intentions. Even if the consequences are the same, underlying...
relationships and mutual support networks can be of more value to self-esteem
Self-esteem
Self-esteem is a term in psychology to reflect a person's overall evaluation or appraisal of his or her own worth. Self-esteem encompasses beliefs and emotions such as triumph, despair, pride and shame: some would distinguish how 'the self-concept is what we think about the self; self-esteem, the...
and recovery.
Empowerment and Inclusion
Empowerment and self-determinationSelf-determination
Self-determination is the principle in international law that nations have the right to freely choose their sovereignty and international political status with no external compulsion or external interference...
are said to be important to recovery, including having self control
Self control
Self control is the ability to control one's emotions, behavior and desires in order to obtain some reward later. In psychology it is sometimes called self-regulation...
. This can mean developing the confidence
Confidence
Confidence is generally described as a state of being certain either that a hypothesis or prediction is correct or that a chosen course of action is the best or most effective. Self-confidence is having confidence in oneself. Arrogance or hubris in this comparison, is having unmerited...
for independent assertive decision making
Decision making
Decision making can be regarded as the mental processes resulting in the selection of a course of action among several alternative scenarios. Every decision making process produces a final choice. The output can be an action or an opinion of choice.- Overview :Human performance in decision terms...
and help-seeking. Achieving social inclusion may require support and may require challenging stigma
Social stigma
Social stigma is the severe disapproval of or discontent with a person on the grounds of characteristics that distinguish them from other members of a society.Almost all stigma is based on a person differing from social or cultural norms...
and prejudice
Prejudice
Prejudice is making a judgment or assumption about someone or something before having enough knowledge to be able to do so with guaranteed accuracy, or "judging a book by its cover"...
about mental distress/disorder/difference. It may also require recovering unpracticed social skills or making up for gaps in work history.
Coping strategies
The development of personal coping strategiesCoping (psychology)
Coping has been defined in psychological terms by Susan Folkman and Richard Lazarus as "constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing" or "exceeding the resources of the person".Coping is thus expending...
(including self-management
Workers' self-management
Worker self-management is a form of workplace decision-making in which the workers themselves agree on choices instead of an owner or traditional supervisor telling workers what to do, how to do it and where to do it...
or self-help
Self-help
Self-help, or self-improvement, is a self-guided improvement—economically, intellectually, or emotionally—often with a substantial psychological basis. There are many different self-help movements and each has its own focus, techniques, associated beliefs, proponents and in some cases, leaders...
) is said to be an important element. This can involve making use of medication
Medication
A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease.- Classification :...
or psychotherapy
Psychotherapy
Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...
if the consumer is fully informed
Informed consent
Informed consent is a phrase often used in law to indicate that the consent a person gives meets certain minimum standards. As a literal matter, in the absence of fraud, it is redundant. An informed consent can be said to have been given based upon a clear appreciation and understanding of the...
and listened
Active listening
Active listening is a communication technique that requires the listener to understand, interpret, and evaluate what they hear. The ability to listen actively can improve personal relationships through reducing conflicts, strengthening cooperation, and fostering understanding.When interacting,...
to, including about adverse effect
Adverse effect
In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery.An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. If it results from an unsuitable or incorrect dosage or...
s and about which methods fit with the consumer's life and their journey of recovery. Developing coping and problem solving
Problem solving
Problem solving is a mental process and is part of the larger problem process that includes problem finding and problem shaping. Consideredthe most complex of all intellectual functions, problem solving has been defined as higher-order cognitive process that requires the modulation and control of...
skills to manage individual traits and problem issues (which may or may not be seen as symptom
Symptom
A symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality...
s of mental disorder) may require a person becoming their own expert, in order to identify key stress
Stress (biology)
Stress is a term in psychology and biology, borrowed from physics and engineering and first used in the biological context in the 1930s, which has in more recent decades become commonly used in popular parlance...
points and possible crisis points, and to understand and develop personal ways of responding and coping.
Being able to move on can mean having to cope with feelings of loss
Grief
Grief is a multi-faceted response to loss, particularly to the loss of someone or something to which a bond was formed. Although conventionally focused on the emotional response to loss, it also has physical, cognitive, behavioral, social, and philosophical dimensions...
, which may include despair and anger
Anger
Anger is an automatic response to ill treatment. It is the way a person indicates he or she will not tolerate certain types of behaviour. It is a feedback mechanism in which an unpleasant stimulus is met with an unpleasant response....
. When an individual is ready, this can mean a process of grieving. It may require accepting past suffering
Suffering
Suffering, or pain in a broad sense, is an individual's basic affective experience of unpleasantness and aversion associated with harm or threat of harm. Suffering may be qualified as physical or mental. It may come in all degrees of intensity, from mild to intolerable. Factors of duration and...
and lost opportunities or lost time
Time
Time is a part of the measuring system used to sequence events, to compare the durations of events and the intervals between them, and to quantify rates of change such as the motions of objects....
.
Meaning
Developing a sense of meaning and overall purpose is said to be important for sustaining the recovery process. This may involve recovering or developing a social or work role. It may also involve renewing, finding or developing a guiding philosophyPhilosophy
Philosophy is the study of general and fundamental problems, such as those connected with existence, knowledge, values, reason, mind, and language. Philosophy is distinguished from other ways of addressing such problems by its critical, generally systematic approach and its reliance on rational...
, religion
Religion
Religion is a collection of cultural systems, belief systems, and worldviews that establishes symbols that relate humanity to spirituality and, sometimes, to moral values. Many religions have narratives, symbols, traditions and sacred histories that are intended to give meaning to life or to...
, politics
Politics
Politics is a process by which groups of people make collective decisions. The term is generally applied to the art or science of running governmental or state affairs, including behavior within civil governments, but also applies to institutions, fields, and special interest groups such as the...
or culture
Culture
Culture is a term that has many different inter-related meanings. For example, in 1952, Alfred Kroeber and Clyde Kluckhohn compiled a list of 164 definitions of "culture" in Culture: A Critical Review of Concepts and Definitions...
. From a postmodern perspective, this can be seen as developing a narrative.
United States and Canada
The New Freedom Commission on Mental Health has proposed to transform the mental health system in the US by shifting the paradigmParadigm
The word paradigm has been used in science to describe distinct concepts. It comes from Greek "παράδειγμα" , "pattern, example, sample" from the verb "παραδείκνυμι" , "exhibit, represent, expose" and that from "παρά" , "beside, beyond" + "δείκνυμι" , "to show, to point out".The original Greek...
of care from traditional medical psychiatric treatment toward the concept of recovery, and the American Psychiatric Association
American Psychiatric Association
The American Psychiatric Association is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential worldwide. Its some 38,000 members are mainly American but some are international...
has endorsed a recovery model from a psychiatric services perspective.
The US Department of Health and Human Services reports developing national and state initiatives to empower consumers and support recovery, with specific committees planning to launch nationwide pro-recovery, anti-stigma education campaigns; develop and synthesize recovery policies; train consumers in carrying out evaluations of mental health systems; and help further the development of peer-run services. Mental Health service directors and planners are providing guidance to help state services implement recovery approaches.
Some US states, such as California
California
California is a state located on the West Coast of the United States. It is by far the most populous U.S. state, and the third-largest by land area...
(see the California Mental Health Services Act
California Mental Health Services Act
In November 2004, voters in the U.S. state of California passed Proposition 63, the Mental Health Services Act , which has been designed to expand and transform California’s county mental health service systems by increasing the taxes of high income individuals...
), Wisconsin
Wisconsin
Wisconsin is a U.S. state located in the north-central United States and is part of the Midwest. It is bordered by Minnesota to the west, Iowa to the southwest, Illinois to the south, Lake Michigan to the east, Michigan to the northeast, and Lake Superior to the north. Wisconsin's capital is...
and Ohio
Ohio
Ohio is a Midwestern state in the United States. The 34th largest state by area in the U.S.,it is the 7th‑most populous with over 11.5 million residents, containing several major American cities and seven metropolitan areas with populations of 500,000 or more.The state's capital is Columbus...
, already report redesigning their mental health systems to stress recovery model values like hope, healing, empowerment, social connectedness, human rights, and recovery-oriented services.
At least some parts of the Canadian Mental Health Association
Canadian Mental Health Association
The Canadian Mental Health Association was founded on January 26, 1918 by Dr. Clarence M. Hincks and Clifford W. Beers. Originally named the Canadian National Committee for Mental Hygiene, it is one of the oldest voluntary health organizations still operating in Canada.Each year, CMHA divisions...
, such as the Ontario
Ontario
Ontario is a province of Canada, located in east-central Canada. It is Canada's most populous province and second largest in total area. It is home to the nation's most populous city, Toronto, and the nation's capital, Ottawa....
region, have adopted recovery as a guiding principle for reforming and developing the mental health system.
New Zealand and Australia
Since 1998, all mental health services in New ZealandNew Zealand
New Zealand is an island country in the south-western Pacific Ocean comprising two main landmasses and numerous smaller islands. The country is situated some east of Australia across the Tasman Sea, and roughly south of the Pacific island nations of New Caledonia, Fiji, and Tonga...
have been required by government policy to use a recovery approach and mental health professionals are expected to demonstrate competence in the recovery model. Australia
Australia
Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...
's National Mental Health Plan 2003-2008 states that services should adopt a recovery orientation although there is variation between Australian states and territories in the level of knowledge, commitment and implementation.
UK and Ireland
In 2005, the National Institute for Mental Health in EnglandNational Institute for Mental Health in England
National Institute for Mental Health in England was an English medical organisation established in 2001 under the leadership of Professor Louis Appleby to "coordinate research, disseminate information, facilitate training and develop services". The NIMHE has now been disbanded and a new body, the...
(NIMHE) endorsed a recovery model as a possible guiding principle of mental health service provision and public education. The National Health Service
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...
is implementing a recovery approach in at least some regions, and has developed a new professional role of Support Time and Recovery Worker. A leading independent charity issued a 2008 policy paper proposing that the recovery approach is an idea "whose time has come". The Scottish Executive
Scottish Executive
The Scottish Government is the executive arm of the devolved government of Scotland. It was established in 1999 as the Scottish Executive, from the extant Scottish Office, and the term Scottish Executive remains its legal name under the Scotland Act 1998...
has included the promotion and support of recovery as one of its four key mental health aims and funded a Scottish Recovery Network
Scottish Recovery Network
The Scottish Recovery Network has been working since 2004 to raise awareness that people can and do recover from long-term and serious mental health problems and to build an understanding of what helps people recover...
to facilitate this. A 2006 review of nursing in Scotland recommended a recovery approach as the model for mental health nursing care and intervention. The Mental Health Commission of Ireland
Ireland
Ireland is an island to the northwest of continental Europe. It is the third-largest island in Europe and the twentieth-largest island on Earth...
reports that its guiding documents place the service user at the core and emphasize an individual's personal journey towards recovery.
See also
- Addiction recovery groupsAddiction recovery groupsAddiction recovery groups are voluntary associations of people who share a common desire to overcome drug addiction. Different groups use different methods, ranging from completely secular to explicitly spiritual. One survey of members found active involvement in any addiction recovery group...
- Anti-psychiatryAnti-psychiatryAnti-psychiatry is a configuration of groups and theoretical constructs that emerged in the 1960s, and questioned the fundamental assumptions and practices of psychiatry, such as its claim that it achieves universal, scientific objectivity. Its igniting influences were Michel Foucault, R.D. Laing,...
- Clinical psychologyClinical psychologyClinical psychology is an integration of science, theory and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development...
- Celebrate RecoveryCelebrate RecoveryCelebrate Recovery was founded in 1991 by Pastor John Baker of Saddleback Church with the goal of overcoming life's issues with a twelve-step program based on Christian principles. This recovery program addresses all types of habits, hurts and hang-ups. Other churches and some prisons implemented...
- DeinstitutionalisationDeinstitutionalisationDeinstitutionalization or deinstitutionalization is the process of replacing long-stay psychiatric hospitals with less isolated community mental health service for those diagnosed with a mental disorder or developmental disability. Deinstitutionalization can have multiple definitions; the first...
- Emotions AnonymousEmotions AnonymousEmotions Anonymous is a twelve-step program for recovery from mental and emotional illness. there were approximately 1,100 EA groups active in the United States. EA is the largest of three organizations that have adapted the Twelve Steps of Alcoholics Anonymous to create a program for people...
- GROWGROWGROW is a peer support and mutual-aid organization for recovery from, and prevention of, serious mental illness. GROW was founded in Sydney, Australia in 1957 by Father Cornelius B. "Con" Keogh, a Roman Catholic priest, and psychiatric patients who sought help with their mental illness in...
- Mental Health America
- Peer supportPeer supportPeer support occurs when people provide knowledge, experience, emotional, social or practical help to each other. It commonly refers to an initiative consisting of trained supporters, and can take a number of forms such as peer mentoring, listening, or counseling...
- PsychiatryPsychiatryPsychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
- PsychotherapyPsychotherapyPsychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...
- Physical medicine and rehabilitationPhysical medicine and rehabilitationPhysical medicine and rehabilitation , physiatry or rehabilitation medicine, is a branch of medicine that aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities. A physician having completed training in this field is referred to as a...
- Recovery International (formerly Recovery, Inc.)
- Social firmSocial firmSocial Firm is the British term for a work integration social enterprise , a business created to employ people who have a disability or are otherwise disadvantaged in the labour market. Its commercial and production activities are undertaken in the context of a social mission, with profits going...
- Social psychiatrySocial psychiatrySocial psychiatry is a branch of psychiatry that focuses on the "interpersonal" and cultural context of mental disorder and mental wellbeing. It involves a sometimes disparate set of theories and approaches, with work stretching from epidemiological survey research on the one hand, to an indistinct...
- Social workSocial workSocial Work is a professional and academic discipline that seeks to improve the quality of life and wellbeing of an individual, group, or community by intervening through research, policy, community organizing, direct practice, and teaching on behalf of those afflicted with poverty or any real or...
- Self-help groups for mental healthSelf-help groups for mental healthSelf-help groups for mental health are voluntary associations of people who share a common desire to overcome mental illness or otherwise increase their level of cognitive or emotional wellbeing. There are several international mental health self-help organizations including Emotions Anonymous, the...
- SoteriaSoteriaSoteria is a community service that provides a space for people experiencing mental distress or crisis. Based on a recovery model, common elements of the Soteria approach include primarily non-medical staffing; preserving resident's personal power, social networks, and communal responsibilities;...
- Therapeutic communityTherapeutic communityTherapeutic community is a term applied to a participative, group-based approach to long-term mental illness, personality disorders and drug addiction...
- The Village Integrated Services AgencyThe Village Integrated Services AgencyMHA: The Village Integrated Services Agency is an internationally known, award winning recovery-oriented program of Mental Health America, Los Angeles located in Long Beach, California. The Village is a non-profit organization that considered a leader in the field of recovery-based mental health care...
(an award-winning non-profit mental health recovery program) - Twelve-step programTwelve-step programA Twelve-Step Program is a set of guiding principles outlining a course of action for recovery from addiction, compulsion, or other behavioral problems...
- United States Psychiatric Rehabilitation AssociationUnited States Psychiatric Rehabilitation AssociationThe United States Psychiatric Rehabilitation Association , formerly known as the International Association of Psychosocial Rehabilitation Services is the professional association for practitioners of the field of psychiatric rehabilitation and persons and families living with psychiatric...