The Theory of Recovery Psychology/The Recovery Model/Chapter One/Part2

The Recovery Approach to Psychological Disorders

Medical Model

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.

• "Recovery model versus Medical model: A Comparision and Analysis Part 3"