The Theory of Recovery Psychology/The Recovery Model/Chapter One: Difference between revisions

Latest revision as of 18:45, 28 June 2009

Introduction to the Recovery Model

The Recovery Model is an approach to mental disorder or substance dependence that emphasizes and supports an individual's potential for recovery. Recovery can be seen within the model as a personal journey requiring hope, a secure base, supportive relationships, empowerment, social inclusion, coping skills, and finding meaning. Originating in programs to overcome drug addiction, the use of the concept in mental health emerged as deinstitutionalization resulted in more individuals living in community settings. It gained impetus due to a perceived failure to adequately support integration, 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. There is some variation between professionalized recovery models and those originating in the consumer/survivor movement. In general medicine or 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 popularised in regard to recovery from substance abuse/drug addiction, for example within twelve-step programs. Application of recovery model concepts to psychiatric disorders is comparatively recent. By consensus the main impetus for the development came from the consumer/survivor 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 psychiatric rehabilitation 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 including populations from virtually every continent, including the landmark World Health Organization crossnational studies from the 1970s and 1990s, showing unexpectedly high rates of where were termed ‘complete recovery’ (20 to 25%) and 'social recovery' (40–45%). The cumulative impact of personal stories or testimony of recovery have 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 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.

Concepts of recovery There is some variation within the Recovery Model. 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 support, 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 US agency statement on mental health recovery, that involved some consumer input, proposed 10 fundamental components of recovery, which it defined it 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. Conferences have been held on the importance of the concept from the perspective of consumers and psychiatrists; such as in the United States the Alternatives, National Association of Peer Speacialists, NAMI and USPRA.

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 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.

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), 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 advances 10 such principles of recovery framed them within a cognitive-behavioral approach.

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. A number of tools have been developed to try to assess aspects of the recovery journey. These include the Recovery Enhancing Environment (REE) measure, the Recovery Measurement Tool (RMT) and the Recovery Oriented System Indicators (ROSI) Measure and 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 common core elements:

Hope Finding and nurturing hope has been described as the key to recovery. It is said to include not just optimism 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 daring to trust in yourself and other people and to risk disappointment, failure and further hurt.

Secure base Appropriate housing, a sufficient income, freedom from violence, and adequate access to healthcare have also been proposed as foundations to recovery.

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 professionals 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.

Empowerment and Inclusion Empowerment and self-determination are said to be important to recovery, including having 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.

Coping strategies The development of personal coping strategies (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 effects 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 symptoms 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.

Coping with loss 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 greiving. It may require accepting past suffering and lost opportunities or lost time.

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 philosophy, religion, politics or culture.

"Part 1" "Part 2" "Part 3" "Part 4" "Part 5" "Part 6"

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 == Introduction to the Recovery Model ==
 The '''''Recovery Model''''' is an approach to mental disorder or substance dependence that emphasizes and supports an individual's potential for recovery. Recovery can be seen within the model as a personal journey requiring hope, a secure base, supportive relationships, empowerment, social inclusion, coping skills, and finding meaning. Originating in programs to overcome drug addiction, the use of the concept in mental health emerged as deinstitutionalization resulted in more individuals living in community settings. It gained impetus due to a perceived failure to adequately support integration, 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. There is some variation between professionalized recovery models and those originating in the consumer/survivor movement.
 In general medicine or 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 popularised in regard to recovery from substance abuse/drug addiction, for example within twelve-step programs.
+[[Category:The Theory of Recovery Psychology]]
 Application of recovery model concepts to psychiatric disorders is comparatively recent. By consensus the main impetus for the development came from the consumer/survivor 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 psychiatric rehabilitation 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 including populations from virtually every continent, including the landmark World Health Organization crossnational studies from the 1970s and 1990s, showing unexpectedly high rates of where were termed ‘complete recovery’ (20 to 25%) and 'social recovery' (40–45%). The cumulative impact of personal stories or testimony of recovery have 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.
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 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 philosophy, religion, politics or culture.
-*[[A Textbook on Recovery Psychology/Unit 1/Chapter One/Part2|''"Recovery model versus Medical model: A Comparision and Analysis Part 2"]]''
+[[A Textbook on Recovery Psychology/Unit 1/Chapter One|''"Part 1"]]''
+[[A Textbook on Recovery Psychology/Unit 1/Chapter One/Part2|''"Part 2"]]''
-== The Recovery Approach to Psychological Disorders ==
+[[A Textbook on Recovery Psychology/Unit 1/Chapter One/Part3|''"Part 3"]]''
-'''Medical Model'''
+[[A Textbook on Recovery Psychology/Unit 1/Chapter One/Part4|''"Part 4"]]''
+[[A Textbook on Recovery Psychology/Unit 1/Chapter One/Part5|''"Part 5"]]''
+[[A Textbook on Recovery Psychology/Unit 1/Chapter One/Part6|''"Part 6"]]''
-The medical model is the traditional approach to treating psychological disorders. It is concerned with remission or the reduction in symptoms, a reduced need for medication and a reduced need for medical and social care services.  In this approach recovery requires a cure for the illness and tends to consider people with psychological disorders as passive recipients of treatment and services.
-'''Recovery Model'''
-In recent years there has been increased recognition that recovery can refer to a person's improved capacity to lead a fulfilled life that is not dominated by illness and treatment.   This is known as the "recovery approach", "psychosocial rehabilitation" or "psychiatric rehabilitation."  It is also terms as the "Recovery paradigm" or the "recovery model."
-In contrast to the medical approach, the recovery approach does not require people to experience reduced symptoms and reduced need for medical and social care; it is about experiencing improved quality of life and higher levels of functioning despite the illness.
-Recovery in this sense does not mean the illness has gone in to complete remission. It means that over time, through what for many is a long and difficult process, individuals come to terms with their illness, learn first to accept it and then move beyond it. They learn to believe in themselves as individuals, learn their strengths as well as their limitations and come to realize that they have the capacity to find purpose and enjoyment in their lives despite their illness. The recovery approach focuses upon the potential for growth within the individual. That potential can then be developed by integrating medical, psychological and social interventions. The recovery model sees individuals with mental illness as active participants in the recovery process.
-Can People With Severe Mental Illness Recover?
-Over time, most people with schizophrenia will make at least a partial medical recovery, within ten years of the onset of illness Approximately 25 % will be in complete remission; 25 % will experience substantially fewer symptoms; 25 % will have slightly reduced symptoms; 15 % will still experience the same level of symptoms; and 10 % will be dead, often as a result of suicide or accident. Overall these recovery rates are better than the recovery rates of diabetes, heart disease and cancer.
-Medical outcomes are better over longer periods of time. Many people will need to take medication for a long time in order to control symptoms and prevent relapse. As people get older their symptoms may change and-or become less severe. Changes in symptoms may lead to different medications being prescribed and this may assist medical recovery.
-A number of factors can be used to predict medical recovery but these are only indicators. Factors, which suggest that a good recovery is likely, include: good adjustment prior to the start of the illness; a family with no history of schizophrenia; developing the illness at an older age; sudden onset of the illness; and, onset of the illness following a major life event.
-Progress and recovery can be helped significantly by positive attitudes and constructive support from family, friends and professionals. Providing training and support to enable people with mental illness to regain social skills and life skills, to engage in work or education will all assist in recovery. Some people with a diagnosis of mental illness will continue to experience symptoms, much of the time or periodically. If, through support and training, they can learn to live fulfilled lives, despite their illness, then they can be thought of as recovered.
-Recovery, in the sense of leading a fulfilled life, despite an illness, requires a belief by both the person with the illness and those around them that the ill person will recover. It requires a commitment to recovery and a recovery strategy, as well as resources to enable recovery and opportunities to share personal growth with others also seeking to recover. Finding a sense of meaning and purpose even in suffering is often thought of as a useful step. For some individuals the illness itself and the adversity associated with it may stimulate personal growth. For others the journey to recovery will feel hard. How far and how quickly each individual recovers will vary widely and it is important to recognize and value every step no matter how small.
-Self-management
-Self-management is an important part of the recovery approach. It is about taking control of ones own life. It is something we all do in coping with life’s difficulties and choosing how we want to live our lives. Self-management can be broken down into four parts: support; stimulation; medication and planning.
-Support
-It is important that a person gets the right support. Family and friends may try to overprotect a person with mental illness, leading to feelings of being stifled and frustrated. Alternatively friends and family may become distant and angry, increasing a persons feeling of isolation. Talking to persons with mental illness about what support they want will help everyone to meet a person with illness’s needs in the best way for that person.
-Stimulation
-It is important that people find the right balance between doing too little, so that their life becomes a vacuum and doing too much, so that they are under stress and more vulnerable to their symptoms. There may be some activities that are too stressful for them but there may be new activities that they can try and enjoy. Professionals try to help their clients learn to recognize situations that are difficult for them and try to find ways of coping with these situations, perhaps with the help of other people.
-Medication
-Consumers of mental health services are encouraged to speak to their psychiatrist or doctor about their medication to ensure that they are receiving the right treatment for them, that side effects have been eliminated as far as possible and to explore whether they are on the optimum dose. What medication works for one may not work for another and it’s likely to take time to find the best one for the individual.
-Planning
-It is important for the consumer to plan in advance what they want to happen if they experience future acute episodes of their symptoms; and to make sure that other people know what the individual wants to happen and what the individual needs to do. Many are advised to consider making an ‘advanced directive’ explaining the person with an illness wants matters to be dealt with, so that it can be held in that persons medical records and also by a relative or friend that is trusted.
-Recovery: An Art or a Science
-What is recovery? According to William Anthony in the Psychiatric Rehabilitation Journal in 1993, it is the development of new meaning and purpose in one’s life as one grows beyond the catastrophe of mental illness (USPRA Audio Conference March 2007). To clearly define recovery, the Substance Abuse and Mental Health Services Administration (SAMHSA) within the U.S. Department of Health and Human Services and the Interagency Committee on Disability Research in a partnership with six other federal agencies convened the National Consensus Conference on Mental Health Recovery and Mental Health Systems Transformation on December 16-17, 2004. Attending this conference were over one hundred and ten stakeholders on the subject of recovery, such as mental health consumers, family members, providers, advocates, researchers, academics, managed care representatives, accreditation organizations, and state and local public officials; who developed this definition: Recovery is a journey of healing and transformation for a person with a mental health disability to be able to live a meaningful life in communities of his or her choice while striving to achieve full human potential or ‘personhood’. (National Consensus Statement on Mental Health Recovery, 2004; SAMHSA 2004). A series of technical papers and reports were commissioned that examine topics such as recovery across the lifespan, definitions of recovery, recovery in cultural contexts, the intersection of mental health and addiction recovery, and the application of recovery at the individual, family, community, service provider, organizational, and system levels.
- This consensus lists these principles as being fundamental to a recovery oriented service system: self-determination, person-driven, holistic, non-linear, strength-based, respect, responsibility, hope, peer-support and empowerment. Consumers must have self-direction to lead, control, exercise choice over, and determine their own path of recovery by optimizing autonomy, independence, and control of resources to achieve a self-determined life. By definition, the recovery process must be directed by the individual, who defines his or her own life goals and designs a unique path towards their goals (National Consensus Statement on Mental Health Recovery, 2004).
-There are multiple pathways to recovery based on an individual’s unique strengths and resiliencies as well as his or her needs, preferences, experiences (including past trauma), and cultural background in all of its diverse representations. Individuals also identify recovery as being an ongoing journey and an end result as well as an overall paradigm for achieving wellness and optimal mental health. Recovery must be an individualized and person-centered experience (National Consensus Statement on Mental Health Recovery, 2004).
-Empowerment is an important fundamental component of recovery. Consumers must the authority to choose from a range of options and to participate in all decisions, including the allocation of services, that will affect their lives, and are educated and supported in so doing, they have the ability to join with other consumers to collectively and effectively speak for themselves about their needs, wants, desires, and aspirations. Through empowerment, an individual gains control of his or her own destiny and influences the organizational and societal structure in his or her life (National Consensus Statement on Mental Health Recovery, 2004).
-Recovery has a holistic component, as recovery encompasses an individual’s whole life, including mind, body, spirit, and community. Recovery embraces all aspects of life, including housing, employment, education, mental health, and health care treatment and services, complementary and naturalistic services, addiction treatment, spirituality, creativity, social networks, community participation, and family supports as determined by the person. Families, providers, organizations, systems, communities, and society play crucial roles in creating and maintaining meaningful opportunities for consumer access to these supports (National Consensus Statement on Mental Health Recovery, 2004).
-Recovery as many have said is non-linear, it is not a step-by-step process but one based on continual growth, with occasional setbacks, and learning from experience. Recovery begins with an initial stage of awareness in which a person recognizes that positive change is possible. This awareness enables the consumer to move on to fully engage in the work of recovery (National Consensus Statement on Mental Health Recovery, 2004).
-Recovery is strength-based. Recovery focuses on valuing and building on the multiple capacities, resiliencies, talents, coping abilities, and inherent worth of individuals. By building on these strengths, consumers leave stymied life roles behind and engage in new life roles such as partner, caregiver, friend, student, or employee. The process of recovery moves forward through interaction with others in supportive, trust-based relationships (National Consensus Statement on Mental Health Recovery, 2004).
-Another essential component of recovery is peer support. Mutual support, including the sharing of experiential knowledge and skills and social learning plays an invaluable role in recovery. Consumers encourage and engage other consumers in recovery and provide each other with a sense of belonging, supportive relationships, valued roles and community (National Consensus Statement on Mental Health Recovery, 2004).
-Community, systems, and societal acceptance and appreciation of consumers, including protecting their rights and eliminating discrimination and stigma are crucial in achieving recovery. Self-acceptance and regaining belief in one’s self are particularly vital. Respect ensures the inclusion and full participation of consumers in all aspects of their lives. (National Consensus Statement on Mental Health Recovery, 2004)
-Consumers have a personal responsibility for their own self care and journeys of recovery. Taking steps towards their goals may require great courage. Consumers must strive to understand and give meaning to their experiences and identify coping strategies and healing processes to promote their own wellness (National Consensus Statement on Mental Health Recovery, 2004)
-Hope last but by far not the least fundamental component of recovery. Recovery provides the essential and motivating message of a better future, that people can and do overcome the barriers and obstacles that confront them. Hope is internalized, but can be fostered by peers, families, friends, providers, and others. Hope is the catalyst of the recovery process. (National Consensus Statement on Mental Health Recovery, 2004)
- Mental health recovery not only benefits individuals with mental health disabilities by focusing on their abilities to live, work, learn, and fully participate in our society, but also enriches the texture of American community life. America reaps the benefits of the contributions individuals with mental disabilities can make, ultimately becoming a stronger and healthier nation (verbatim: U.S. Department of Health And Human Services)
-Lori Ascroft a leader in the recovery movement explains recovery as remembering who you are meant to be prior to the catastrophe of mental illness, and using the skills necessary to be that persons (USPRA Audio Conference March 2007). Pioneering consumer Patricia Deegan, recovery refers to the “lived experience” of gaining a new and valued sense of self and of purpose (Deegan, 1988).
-Recovery is not something that mental health or behavioral health workers do; it is something that consumers do. Recovery belongs in the hands of the consumers, not the staff. Psychiatric treatment and psychiatric rehabilitation (PsyR) differ in theory and premise; treatment refers to medical model of intervention for helping persons with mental illness, where as the latter is the psychosocial reintegration of persons with mental illness in to a natural environment, which is not the patient or client environment. This patient or client environment is an institutionalized existence, often living a life controlled by bureaucratic institutions of our society and those in this environment live complicated lives that persons with out mental illness may never experience or know about. So in that respect recovery is a form of liberation.
-Psychiatric treatment and psychiatric rehabilitation can assist the individual with a mental illness get to their recovery. The latter refers to professional mental health services that bring together approaches from the rehabilitation and the mental health fields (Cook et al., 1996). These services combine pharmacological treatment, skills training, and psychological and social support to clients and families in order to improve their lives and functional capacities. Recovery, by contrast, does not refer to any specific services. The recovery model of psychiatric rehabilitation can assist the medical model of psychiatric treatment, in facilitating recovery. However, recovery is owned and experienced by the consumer.
-Recovery as a philosophy
-Patricia Deegan has defined recovery as a self-directed process and that recovery doesn’t mean the same as “cured”. Recovery is not necessarily a return to a former level of functioning; it involves the development of new meaning in one’s life. Dr Anthony has defined recovery as personal and unique process of changing one’s attitudes, values, self-concept and goals. It is finding ways to live a hopeful, satisfying, active and contributing life. Mary Ellen Copeland developed the Wellness Recovery Action Plan (WRAP) with five components; providing hope, facilitating individuals taking responsibility, facilitating individuals educating themselves, facilitating individuals advocating for themselves, and facilitating individuals gaining and building support networks. This WRAP program helps those who make it work for them. It is a program that is driven by the by individual who is participating in it. It consists of ways to help cope with symptoms and stressors, maintaining a healthy lifestyle and preventing relapses or crisis’s.
-Copeland has outlined certain behaviors as central to providing services within the Recovery model; she includes in her outline treating people with dignity, respect, compassion and unconditional high regard, acceptance of people as unique and special, understanding individuals as growing and working towards achieving goals, considering individuals as experts on themselves, affirming individuals as being in control of their own treatment and recovery, and reminding individuals that there are no limits to their recovery.
-Further Copeland states that for a mental health service to facilitate recovery appropriately the staff must be willing to listen closely to individuals’ views, validate the individuals experience and personhood, providing individuals with non-punitive support, include family when the individual wants their involvement, informing individuals about treatment choices and self-help strategies, respect mutual learning between individuals and providers, work to facilitate increased self-esteem and confidence, respect self-determination and recognize the equality of all people.
-Needs are not the same as services. In the recovery model; medication and other services and interventions are just tools that may or may not be used to facilitate individuals reaching their goals and meeting their needs.
-Psychiatric Disability
-A psychiatric disability can be compared to a physical disability (Anthony, Cohen, & Farkas, 1990: Deegan, 1988). Despite that for the most part that two fields and their clientele are not likely to be closely similar. In both the physical disabled as well as the psychiatrically disabled total and complete recovery is certainly possible. The question has been asked by workers in the psychiatric rehabilitation should less be done for those with psychiatric disabilities than those other disabilities. If a person were injured and rendered to be wheel-chair bound there would be rehabilitation possibilities for this person; it would stand to reason that a person who develops a psychiatric disability for an example schizophrenia, that an equal opportunity for rehabilitation would be offered.
-The field of psychiatric rehabilitation emphasizes the treating of the consequences of the illness rather than treating the illness itself. This has helped those working in the mental health care field better understand the full impact of psychiatric conditions. In the 1980’s proponents of psychiatric rehabilitation such as Mikal Cohen, William Anthony, Robert Paul Liberman and Marianne Farkas have emphasized this full impact in the terms of significant functional limitations, disabilities or handicaps. The World Health Organization (WHO) had already developed a model of illness which not only discussed the illness itself but consequences of that illness. Using the WHO classification system that recognized mental illness in the terms of impairment, dysfunction, disability and disadvantage came to be known as the psychiatric rehabilitation model.
-Mental health treatment attempts to treat the symptoms of illness. Rehabilitation has been more directed at maximizing the health of the individual. Eliminating or suppressing the symptoms does not necessarily lead to improved role functioning. Nor does a decrease in an individuals disability lead to a reduction in symptoms, although it is entirely possible and severe impairment does not have to be permanent.
-Two strategies of the practice of psychiatric rehabilitation which are similar to physical rehabilitation of physical disability are personal skills development, and environmental support development. This basic philosophy is common in the rehabilitation of both mental and physical disabilities. It is based on the idea that persons with disabilities need to achieve their goals and fulfill their roles in life. These interventions are designed to lessen the dysfunction and are assumed to lessen the disability. A major intervention that has helped persons with psychiatric disabilities is societal rehabilitation. The Americans with Disabilities Act (1990) and the recent effort to achieve health benefit parity between those with physical and psychiatric disabilities.
-Recovery Research
-Recovery is a multi-dimensional concept. There is no single measurement for it. It has to be studied by measuring many different measurements that estimate the various components (Anthony 1991). A comprehensive operational definition of recovery must include normative levels of social and occupational functioning; such as independent living, and remission or non-intrusive psychiatric symptoms.
- Psychological data collected for the research of recovery is expanding the language of recovery research. Healing, self-determination and empowerment are important anticipated results of this research (Anthony 2002). The suggested working guide for outcome research targets the following domains of recovery; instrumental role functioning, subjective well being, self-esteem, psychosocial adjustment, quality of life, health status and symptomology (Rogers, Farkas & Anthony 2005).
- Recovery from mental illness is a non-linear process; there are no A-B-C-D-E-F stages in recovery. For each person recovery is different and an individual process. A person in recovery can jump from A to D to B to C in their process. Recovery does not have one starting point, or one destination. Whether it’s number one, number five, or number thirty on the task list, the goal is to just start moving forward in any area, in any increment. (Crowley, 1997 Report of the Wisconsin Blue Ribbon Commission on Mental Health)
- Since recovery is non-linear so is the study of it. Psychiatric rehabilitation practitioners use evidence based practices. The scientific method may be useful in psychology research, but a majority of psychology research with regards to mental illness has been to study the medical aspects of mental illness. The empirical rationale for the recovery model is based on qualitive studies, instead of quantitive studies. The anecdotal evidence from accounts peoples own recovery, the long term outcomes studied in research by Courtney Harding, and research studies of community integration of persons recovering in the areas of living, learning, working, socialization and vocational skills are the crux of this research.
-Written testimonials by former mental patients have appeared for centuries. These writings, according to historian of medicine Roy Porter, “shore up that sense of personhood and identity which they feel is eroded by society and psychiatry” (Porter, 1987). What distinguishes the contemporary wave of writings is their critical mass, organizational backing, and freedom of expression from outside the confines of the institution. Deinstitutionalization, the emergence of community supports and psychosocial rehabilitation (PSR), and the growth of the consumer and family advocacy movements all paved the way for recovery to take hold (Anthony, 1993).
-The concept of recovery continues to be defined in the writings of consumers. These lay writings offer a range of possible definitions, many of which seek to discover meaning, purpose, and hope living with mental illness (Lefley, 1996). However, these definitions do not imply full recovery, in which full functioning is restored and no medications are needed. Instead they suggest a journey or process, not a destination or cure (Deegan, 1997). One of the most prominent professional proponents of recovery, William A. Anthony, summarized consumer writings on recovery with the following definition: “. . . a person with mental illness can recover even though the illness is not cured . . . . [Recovery] is a way of living a satisfying, hopeful, and contributing life even with the limitations caused by illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness” (Anthony, 1993).
-The definitions of recovery from consumer writings vary somewhat but all have degree of commonality. “One of the elements that makes recovery possible is the regaining of one’s belief in oneself” (Chamberlin, 1997). “Having some hope is crucial to recovery; none of us would strive if we believed it a futile effort. . .I believe that if we confront our illnesses with courage and struggle with our symptoms persistently, we can overcome our handicaps to live independently, learn skills, and contribute to society, the society that has traditionally abandoned us” (Leete, 1989). “A recovery paradigm is each person’s unique experience of their road to recovery. . . .My recovery paradigm included my reconnection which included the following four key ingredients: connection, safety, hope, and acknowledgment of my spiritual self”(Long, 1994). “To return renewed with an enriched perspective of the human condition is the major benefit of recovery. To return at peace, with yourself, your experience, your world, and your God, is the major joy of recovery” (Granger, 1994).
-Impact of the recovery concept
-The treatment success rates for many mental health disorders surpass those of other medical conditions, such as heart disease. Here are some statistics: depression, more than 80 percent; panic disorder, 70 percent to 90 percent; schizophrenia, 60 percent; heart disease, 45 percent to 50 percent. (National Institute of Mental Health, 2002)
-Early research in 1987 by Courtney Harding and others challenged the belief that severe mental illness is chronic and that stability is the best one could hope for. They discovered that there are a variety of outcomes associated with severe mental illness and that many people did progress beyond a state of mere stability. As a result, the concept of recovery began to obtain legitimacy
-At the heart of the recovery movement is the idea that instead of focusing on the disease or pathological aspect of schizophrenia, as does the medical model, emphasis is placed on the potential for growth in the individual. That potential is then developed by integrating medical, psychological and social interventions.”(APA Monitor, February 2000)
-Mental Health System Design Errors
-In the past the Mental Health system had confused the terms like services, programs and settings. Underlying values were not explicated; there was a lack of focus on the consumers goals, a failure to understand the concept of the consumers’ preference on the levels of intervention, a lack of emphasis on substance with in the services and limited vision. Many innovations have been implemented to strive for a better mental health system. The reforming most of the mental health system has been directed by professional organizations and stakeholder organizations such as United States Psychiatric Rehabilitation Association (USPRA), the National Alliance on Mental Illness (NAMI), Substance Abuse and Mental Health Administration (SAMHSA), National Institute of Mental Health (NIMH) and the National Mental Health Association (NMHA) but the greatest contribution to the improvements made have been made by the consumer movement.
-Recovery is not a new idea it dates back through out history. Dorothea Lynde Dix in 1854 stated “Recovery is the rule, permanent disease the exception”
-Thomas S. Kirkbride, MD in 1880 stated “…it is safe to say that as many as eighty percent may be expected to recover”
-Aaron J. Rosanoff, MD in 1920 said “Recovery with complete return to health is the rule”
- David Henderson MD and RD Gillespie in 1952 are quoted as saying “Recoverable means that degree of recovery which would enable the patient to undertake again the ordinary responsibilities of marriage. It does not mean capable of improvement to the extent of merely being able to live outside of a mental hospital…’
-Lori Ashcaft Ph.D. and William A. Anthony Ph.D. in an article entitled, A Story of Transformation: An Agency Fully Embraces Recovery, explain that a recovery culture: “…focuses on each person’s inherent strengths, abilities and capacity to learn new skills for living and for developing personal growth, mutuality and recovery.
-Lori Holman wrote a book, Next Year I’ll Plant Tulips about her own recovery she is quoted as saying “I would say to anyone that recovery never just walks in the door. I worked hard at it for years.”
-Again, What is Recovery?
-Recovery is a self-directed process of healing and transformation. Recovery is a process an outcome, and a vision. Recovery is a deeply personal, unique process of adjusting one’s attitudes, feelings, perceptions, beliefs, roles, and goals. The process of recovery may be described as a journey of the heart. It does not mean a person did or does not have a mental illness. Although very rarely, it can occur without professional intervention. Often people who recover have people who stand by and believe in them. Recovery is not always a linear process. Recovery can occur despite the return of symptoms.
-Recovery is seen as a threefold process. Not only do persons with Mental Illness recover, but so do behavioral health caretakers recover from their long held beliefs and misconceptions about consumers; and overall society recovers from its history of prejudice. Consumers recover from the major losses of family and friends, people and opportunities, the catastrophe of mental illness, trauma, mistreatment, crushed dreams, the lack of sense of self, valued roles and hope and from the stigma and discrimination in society.
-The care givers recover from worn-out belief systems, hopelessness, the need to be in control, disbelief in a consumers abilities and the fear of mental illness. Society recovers from stigmatizing mental illness, false beliefs about mental illness, misguided values and discrimination.
-The symptoms of recovery are a fulfilling life, dreams and goals, friendship, membership in the community and meaning and purpose. Recovery is sometimes viewed as a destination, a journey, a vision, a process, a way of life, a long term goal, a personal odyssey, an adventure or a growth process. Over the last 150 years the term recovery has been defined as the following: cured, improved enough to be discharged from the hospital, complete symptom remission, being a whole person, being able to resume functional roles in life, returning to ‘normal’, living life to the fullest, being able to work or go to school, being a contributing member of the community, having a better quality of life, taking responsibility with self-determination, no longer needing medication and developing purpose and meaning in life. Maybe recovery is all of these or in part some of each one of these. Since no two people are the same or experience illness the same, it would be difficult for recovery to be the same for everyone.
-For those who embrace the Recovery philosophy, the unifying theme is usually the belief in the possibility, the probability or the certainty of persons with mental illness having better, happier and healthier lives.
-Opposition to the recovery concept
-The neurological research of mental illness is conducted by NIMH (National Institute of Mental Health); this is given the sociopolitical support of NAMI (National Alliance on Mental Illness) and is funded largely by Eli Lily Pharmaceuticals in a quid pro quo alliance. It is the view of some who oppose the recovery concept, that recovery is a smoke screen to shield the pharmaceutical industry from potential lawsuits and from any possible criticism regarding the dangers of taraditive dyskinesia and other harmful effects. The recovery concept is viewed as being Eli Lily Corporations propaganda.

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Latest revision as of 18:45, 28 June 2009

Introduction to the Recovery Model