Title: Recovering Mental Health in Scotland: Report on Narrative Investigation of Mental Health Recovery
Authors: Wendy Brown and Niki Kandirikirira
Affiliations: Scottish Recovery Network
The concept of recovery in mental health has received increasing attention in recent years. It is a concept however open to varying interpretation and one where some clarity of definition and application must be sought. The Scottish Association for Mental Health suggests that “recovery is a belief that people can live a fulfilling life, regardless of the problems and difficulties they may be facing”. It is not about the presence or absence of symptoms but about achieving a satisfying life often recovery is portrayed as a journey.
Promoting and supporting recovery is one of the four key aims of the Scottish Government’s National Programme for Improving Mental Health and Wellbeing. The Scottish Recovery Network (SRN) is part of that programme and designed this research in order to understand from personal accounts – “recovery narratives” – how a range of different individuals had experienced mental health recovery. Individuals defining themselves as ‘recovering from or having recovered from long-term mental health problems’ were recruited through ads in local and national press, through SRN mailings, and through a range of existing contacts. Those who responded were screened by a trained counsellor to confirm their suitability to participate: “where the applicant was felt not ready to participate, the decision to withdraw was taken by that person” (p12). Quotas were set to ensure the sample included a diverse range of individuals the research was oversubscribed and once quotas were filled individuals were encouraged to submit their recovery story to the SRN in writing.
Sixty-four individuals completed a structured questionnaire to provide background demographic information and then participated in a semi-structured narrative interview exploring their recovery journey. Respondents were given details of the topic guide in advance it focused on factors that had helped and detracted during the process of recovery, factors that had helped to sustain wellbeing, and a description of what recovery felt like for them. The research approach was participatory. For example the design was developed in collaboration with a number of active groups, transcripts were returned to participants for checking, and recruitment of interviewers who had experienced mental health problems and recovery was encouraged.
Several key themes emerged from the detail of the completed narratives. These are explored in the six core chapters of the report, together with relevant literature and policy implications.
Recovering identity highlights a variety of triggers that had enabled individuals to start regaining a sense of identity, including having confidence and optimism that recovery can happen, taking responsibility for one’s own wellbeing, rejecting the negative identity of ill health, and increasing self-esteem. Becoming engaged identifies how different forms of engagement (volunteering, employment, education, community and social participation, civic and political engagement) can contribute to recovery if they offer activity, meaning, purpose and a sense of belonging.
Conversely, barriers such as stigma, pessimism, undervaluing individual contributions and fear of failure may inhibit engagement. Developing relationships explores the impact of positive and negative relationships on recovery. The former tend to be characterised as supportive, understanding, consistent and reciprocal and are based on trust, whereas criticism and a sense of not being listened to signify the latter.
Individuals’ experiences of diagnosis and support and the features that promote recovery are detailed in Treatment and Supports. Continuity and flexibility of support systems assisted recovery, offering choice in therapies and treatments and allowing individuals to determine when they no longer needed support. Individuals valued holistic support that encompassed for example housing and finances. The chapter titled Pacing and Turning highlights the importance in the recovery journey of key turning points, triggers which offer a shift in perspective from someone defined by their illness to individuals with choices and responsibility. Often these are described as unplanned, a chance encounter or a sudden realisation. Finally, Reframing for Recovery, reflects the philosophy from the accounts in this study that recovery from enduring mental ill health is possible, achieving a new way forward despite the limitations that illness may impose.
These summary findings cannot convey the richness and depth of the detailed narratives that are presented. One of the strengths of the detailed quotations from the narratives included in this report is that they provide a much clearer understanding of the concept of recovery than the bare discussion of definitions. Such an understanding is necessary to avoid multiple interpretations both across and within professional groups. Moreover the extensive links to the wider literature base are well presented.
Nonetheless it is important to remember that these are the recovery narratives of self-nominated individuals, individuals who by definition have found value in the recovery approach and are motivated to recount their experiences. This is not to diminish in any way the accounts presented here rather it is an argument that they be read within that context, as a detailed illumination of how a constellation of different factors can contribute to individual achieving recovery. Capturing the essential nature of recovery presents a methodological conundrum: ‘using narrative or story collection as a research method allowed us to acknowledge that each person’s experience of recovery is unique, that definitions of recovery vary and that the criteria people use to measure their progress are difficult to quantify or compare’.
Despite these challenges, the authors conclude that the accounts suggest that six basic elements need to be in place for recovery to proceed. These are a belief in self and developing a positive identity knowledge that recovery is possible meaningful activities positive relationships with others and with the environment an understanding of the illness, of mental health and of wellbeing and proactive strategies to stay well and manage setbacks. In addition six external elements which promote recovery journeys are identified: supportive family and friends being told recovery is possible a recognition and valuing of contributions formal support responsive to changing needs living and working in a community where people see beyond the illness and having life choices accepted and validated. This suggests a somewhat different prescription in response to the needs of those with enduring mental ill health than that traditionally offered.
Alison Petch is director of Research in Practice for Adults. Ripfa promotes the use of evidence informed practice in the delivery of adult social care services. More information at
LINKS AND RESOURCES
● The Scottish Recovery Network has published additional materials derived from this study. Journeys of Recovery (2006) contains 12 individual narratives these can also be accessed through four podcasts and on audio CD. Routes to Recovery (2007) is a booklet offering tips and strategies derived from the research findings.
● The Network has also produced a series of discussion papers accessible through their website at www.scottishrecovery.net.
● Bradstreet S (2004), Elements of Recovery: International Learning and the Scottish Context, SRN Discussion Paper Series, Report No 1, Glasgow: Scottish Recovery Network
● Dorrer N (2006), Evidencing Recovery: The ‘Ups’ and ‘Downs’ of Longitudinal Outcome Studies, SRN Discussion Paper Series, Report No 4, Glasgow: Scottish Recovery Network
● Coutts P (2007), Mental Health, Recovery and Employment, SRN Discussion Paper Series, Report No 5, Glasgow: Scottish Recovery Network
● McCormack J (2007), Recovery and Strengths Based Practice, SRN Discussion Paper Series, Report No 6, Glasgow: Scottish Recovery Network
● The Care Services Improvement Partnership, the Royal College of Psychiatrists and the Social Care Institute for Excellence have collaborated on A Common Purpose: Recovery in Future Mental Health Services (2007)