So what is this “Recovery” talk in mental health really all about?

More and more there is a growing interest in “recovery” happening throughout the mental health community, both locally here in Central East Ontario and globally as well. Recovery has become the latest “buzz word” in mental health circles – agencies are beginning to explore what changes it will take to embrace a “recovery philosophy”. Recipients of mental health services are also hearing a message about recovery and are growing cautiously hopeful that their lives might be different – that for each individual it will be possible to move beyond a debilitating psychiatric diagnosis to a meaningful quality of life as defined by oneself.

So what is this recovery talk all about anyway? What makes “recovery” different from the “status quo” of mental health services we know today? First, it is important to note that recovery is still very much a foreign concept to many in the mental health field. Until recently recovery and exiting the mental health system was not thought possible by many family members, researchers and medical professionals. In fact, the possibility of recovery is still debated by some. At its most fundamental level, recovery challenges the status quo by promoting the belief that people can heal and get well from the most serious mental distress and mental “illnesses” – that they can rebuild and regain their lives through a journey of renewal and perhaps even transformation – that rehabilitation and maintenance are no longer the end goal but instead reintegration and connection with community, friends, and a fulfilling and meaningful life.

The genesis for mental health recovery has been in the consumer/ex-patient movement that took place globally in the 1970’s as a direct response to deinstitutionalization. The term “recovery” first emerged in the late 1980’s and early 1990’s in consumer/survivor narrative accounts of their recovery being published in biographies and for the first time in professional journals. Changes started to happen from within the mental health system in 1993 when psychiatric rehabilitation professionals led by Boston University and William Anthony, challenged the US mental health services to adopt a recovery vision and transform their services to a recovery orientation. The ensuing 14 years have seen the recovery story spread throughout the USA and to far away points such as the UK, Ireland, Europe, Australia, New Zealand and Iceland to name a few. Although the recovery message has come late to Canada, it has gained strides, especially in Ontario, over the past two years.How do we know people can recover – what’s the proof? With respect to outcomes research, a number of long-term longitudinal studies ground hope for recovery in substantial empirical findings. These studies were conducted in different countries including the USA, Japan, Switzerland and Germany. Research participants were studied over a range of 22-37 years with a recovery rate reported varying from 46-68%. Sadly, this story, that half to two-thirds of people diagnosed with major mental illnesses, including schizophrenia, go on to significant or full recovery, rarely, if ever, gets told, especially by medical professionals.

hopeInitial research into recovery has focused on attempts to theoretically describe recovery through conceptualizing models – What does it look like? How does it happen? What helps and hinders? A common thread in these models is recognition that mental health recovery involves a unique process, both internal and external for individuals. Internal conditions for recovery include resilience and hope, healing, empowerment and taking personal responsibility, reaching out for support and connection. Other themes emerging are the importance of self-advocacy and self-education, especially around coping with symptoms and self-management strategies. External conditions include upholding human rights, a positive culture of healing in the home and service setting, and recovery-oriented services that offer choices and self-direction.

So returning to the original question posed, “What is recovery talk all about?” one might conclude that recovery encompasses a fundamental shift in power, attitude and beliefs regarding the prognosis for someone who has been diagnosed within the mental health system. Recovery demands an emphasis on collaboration between providers and service-users as opposed to individual dependency on the system and profound loss of personal control. Treatment approaches call for a move beyond the current over-reliance on pharmaceutical drugs and “pill medicine” to an exploration of “personal medicine”, like exercise, meditation, yoga, creative activities to name a few, and a better balance with “talk medicine” techniques such as therapy and self-help, peer support groups. Providers and family members need to focus all their energies on creating an environment that will nurture recovery and as Patricia Deegan, a highly regarded recovery activist, states, it is up to individuals experiencing mental distress to strive towards becoming “the unique, awesome, never to be repeated human being that we are called to be”.

Ann Thompson,
November 26, 2007