Uses and abuses of recovery: implementing recovery-oriented practices in mental health systems

Abstract

An understanding of recovery as a personal and subjective experience has emerged within mental health systems. This meaning of recovery now underpins mental health policy in many countries. Developing a focus on this type of recovery will involve transformation within mental health systems. Human systems do not easily transform. In this paper, we identify seven mis-uses ("abuses") of the concept of recovery: recovery is the latest model; recovery does not apply to "my" patients; services can make people recover through effective treatment; compulsory detention and treatment aid recovery; a recovery orientation means closing services; recovery is about making people independent and normal; and contributing to society happens only after the person is recovered. We then identify ten empirically-validated interventions which support recovery, by targeting key recovery processes of connectedness, hope, identity, meaning and empowerment (the CHIME framework). The ten interventions are peer support workers, advance directives, wellness recovery action planning, illness management and recovery, REFOCUS, strengths model, recovery colleges or recovery education programs, individual placement and support, supported housing, and mental health trialogues. Finally, three scientific challenges are identified: broadening cultural understandings of recovery, implementing organizational transformation, and promoting citizenship.

Applying a Mental Health Recovery Approach for People from Diverse Backgrounds: The Case of Collectivism and Individualism Paradigms

“…While the achievement of cure is more desirable, the former is more achievable and allows greater therapeutic optimism' [4, p. 176]. For more details on benefits on recovery approach, see a recent review by Slade [5].…”

Recovery from severe mental illness

“…The enthusiasm for the concept of recovery is shared across diverse sectors, including patient advocates, clinicians, researchers and governments, which has resulted in a general consensus that the adoption of a recovery orientation throughout health services is desirable. 9 Adoption involves several factors related to everyday clinical work, including adopting a positive, optimistic and hopeful attitude when working with people with severe mental illness, eliciting information on subjective life goals and working with patients to help achieve those goals, 5 and enacting shared decision-making in the clinical encounter, especially in medication management, 1 so that patients have choice and autonomy regarding intervention options.…”

“…8,9 Moreover, new approaches (e.g., shared decision-making) involve skills that may require additional training and extra time spent in consultations. 1,5 The practice of psychiatry was traditionally based on the biopsychosocial model, which emphasized a holistic approach to healing. 10 However, convincing arguments have been made as to psychiatry's recent switch to a de facto "bio-bio-bio" model.…”

“…1 Autonomy and choice in mental health care are considered central to the concept of recovery. 5 The concept of recovery is supported by scientific evidence. Epidemiologic research has consistently shown that severe mental illness is not always a lifelong or even a chronic condition; substantial numbers of people with severe mental illness have a reduction of both symptoms and associated secondary impairments over time.…”

“…6 Health services research has shown strong evidence for psychosocial interventions (e.g., supported employment) that promote recovery by helping people achieve autonomy and life progress. 5 Cross-national comparisons have shown that people with severe mental illness have better outcomes in places where they remain integrated within families, workplaces and communities. 7 Numerous autobiographic and qualitative accounts have shown the reality of recovery: people can define and achieve important life goals despite ongoing symptoms.…”