Recovery and mental health

The Social Care Institute for Excellence’s analysis of research findings behind specific social work practices. Appearing in the 4 September issue of Community Care magazine, this article focuses on research findings about recovery from mental health problems

There is increasing national and international interest in the concept of “recovery” in the field of mental health and psychiatry. It is a concept that has attracted enthusiasm and hope in an area often ­characterised by disillusion and defeat. The interest in recovery arose from the experiences of people with severe mental health problems. Since then professional bodies, health care agencies and governments have become more interested in adopting recovery as the guiding principle for mental health policy, practice and services.

In mental health services recovery has three main meanings: a spontaneous and natural event – overcoming problems without intervention, the intended consequence of the skilful use of the full range of effective treatments, and finally personal recovery that can occur in the context of continuing symptoms or disabilities.

The first usage relates to resilience and robustness and is poorly understood the second is the focus of evidence-based practice and treatment guidelines and the third is about recovery of hope and ambition for living full and purposeful lives whatever the circumstances. It is this definition that is informing some current thinking on direction in mental health services.

Evidence

An emphasis on personal recovery focuses on collaboration, partnership working and self-directed care, all of which lead to choice and control for people who use services, their families and other supporters.

A recovery approach may be applicable across various client groups and connects with many of the ways in which cultures other than Europeans approach health challenges. It is an approach that values different cultural understandings and, as such, can begin to fuse learning from our current UK population that includes European, Eastern and African views to inform services for the 21st century.

Recovery is the process of regaining active control over one’s life. This may involve discovering (or rediscovering) a positive sense of self, accepting and coping with the reality of any continuing distress or disability, finding meaning in one’s experiences, resolving personal, social or relationship issues that may contribute to one’s mental health difficulties, taking on satisfying and meaningful social roles, and calling on formal and/or informal systems of support as needed.

The need for services will vary. For some people, recovery may mean exiting from mental health services permanently or for much of the time. For others it may mean continuing to receive ongoing forms of medical, personal or social support that enable people to get on with their lives.

Key themes in recovery

● Recovery is about a set of values related to human living applied to the pursuit of health and wellness.

● Recovery involves a shift of emphasis from pathology, illness and symptoms to health, strengths and wellness.

● Hope is of central significance. If recovery is about one thing it is about the recovery of hope, without which it may not be possible to recover. That hope can arise from many sources, including being believed and believed in, and the example of peers.

● Recovery involves a process of empowerment to regaining active control over one’s life. This includes developing confidence and taking increasing personal responsibility through effective self-care, self-management and self-directed care.

● Finding meaning in and valuing personal experience can be important, as is faith including religious or secular spirituality.

● Recovery approaches are positive about cultural, religious, sexual and other forms of diversity as sources of identity and belonging.

● Recovery is supported by resolving personal, social or relationship problems and both understanding and realistically coming to terms with ongoing illness or disability.

● Recovery is associated with social inclusion and being able to take on meaningful and satisfying social roles in society and gaining access to mainstream support such as housing, adequate personal finances, education and leisure facilities.

● There is a pivotal need to discover (or rediscover) a positive sense of personal identity, separate from illness and disability.

● The language used and the stories and meanings that are constructed around personal experience, conveyed in letters, reports and conversations, have significance as mediators of recovery processes. These shared meanings either support a sense of hope or carry an additional weight of morbidity, inviting pessimism and chronic illness.

● Treatment is important but its capacity to support recovery lies in the opportunity to arrive at treatment decisions through negotiation and collaboration.

● Recovery-based services emphasise the personal qualities of staff as much as their formal qualifications, and seeks to cultivate their capacity for hope, creativity, care and compassion, acceptance and resilience.

● To support personal recovery, services need to move beyond preoccupations with risk avoidance and a narrow interpretation of evidence-based approaches towards working with creative risk-taking and what is meaningful to the individual and their family.

Further information

● Knowledge review 21: Supporting People in Accessing Meaningful Work: Recovery Approaches in Community-based Adult Mental Health Services

● Position paper 08: A Common Purpose: Recovery in Future Mental Health Services

● Research resource 03: The Recovery Approach in Community-based Vocational and Training Adult Mental Health Day Services

● National Institute for Mental Health in England

● Social Perspectives Network

● Rethink

● Mind

Research abstracts around the theme of mental health recovery

Author STANHOPE Victoria SOLOMON Phyllis

Title Getting to the heart of recovery: methods for studying recovery and their implications for evidence-based practice

Reference British Journal of Social Work, 38(5), July 2008, pp885-899 ISSN paper: 0045-3102 ISSN online: 1468-263X

Abstract Interaction between social workers and clients continues to be an understudied aspect of interventions. Recovery places an emphasis on therapeutic relationships, demanding that providers collaborate closely with each consumer to discover their unique path to healing. As a result, researchers must also reorient their focus from the structure of services to the processes that take place during service delivery. Qualitative methods are recommended to enhance micro-level study of complex human processes within their social context. The authors argue that a broader understanding of evidence is needed to ensure that research is relevant to social work practice.

Author FOX Joanna

Title Experience of mental health recovery and the service user researcher

Reference Ethics and Social Welfare, 1(2), July 2007, pp219-223

Abstract The author – a service user with schizophrenia – discusses how she can use her position and produce research that is acceptable, reliable and credible. She discusses this in relation to a research proposal to examine the role of the carer in the recovery process of people with schizophrenia.

Author NATIONAL INSTITUTE FOR MENTAL HEALTH IN ENGLAND

Title Emerging best practices in mental health recovery

Publisher National Institute for Mental Health in England

Abstract These practices were developed as a guide for mental health service users to explore their understanding of their potential roles in the recovery process and as self-advocates for the delivery of quality services by staff. This model attempts to clarify some of what people in recovery have discovered during their personal recovery journeys about their roles and the roles of other people in the recovery process.

Editors HALL Angela WREN Mark KIRBY Stephan

Title Care planning in mental health: promoting recovery

Publisher Blackwell

Abstract The concept of recovery is examined as an inherent aspect of the care planning process. Practical guidance, theoretical background and personal “real life” context are provided within the framework of planning for mental health recovery. The book begins by addressing the concept of care planning from the ground up, with a discussion of care planning and practical issues of application. Personal experiences of care planning are then shared, allowing the core theme of the book to be explored – that of promoting recovery. The final chapters draw the key issues together providing practical, up to date and evidence-based discussion.

Author BROWN Wendy KANDIRIKIRIRA Niki

Title Recovering mental health in Scotland: report on narrative investigation of mental health recovery

Publisher Scottish Recovery Network

Abstract By using a narrative method, the report states that people in recovery from long-term mental health problems are experts by experience and reminds us that people can and do recover.