In this series, I dig a little deeper into the meaning of psychological terms. This week’s term is mental illness recovery.
The word recovery can have various connotations depending on the context. It began to gain popularity in the context of mental health in the late 1980s and early 1990s, when it was used by the ex-patient/psychiatric survivor movement. Its usage has become common in mental health services, and various mental health-related government agencies claim to have some degree of recovery orientation.
According to the Mental Health Commission of Canada (MHCC), “‘Recovery’ does not necessarily mean ‘cure’; rather, it focuses on people recovering a meaningful life in their community while striving to achieve their full potential.” Recovery is unique for each individual, and draws upon strengths. In the recovery process, individuals with mental illness are empowered and enabled to live a meaningful life. Principles that support recovery include hope, empowerment, self-determination, and responsibility.
The recovery process
Recovery is described a little differently by different organizations Here are a few perspectives.
Mental Health Commission of Canada
The MHCC developed a set of guidelines for recovery-oriented mental health services. These were built around several key dimensions, including:
- Creating a culture and language of hope.
- Recognizing that recovery is personal and unique, and requires consideration of the whole person. There is a focus on strengths, autonomy, and self-determination.
- Recognizing that recovery occurs in the context of one’s life, which is impacted by such factors as social supports, social determinants of health, and stigma.
- Taking into account the diverse needs of all groups within Canada including Indigenous peoples, LGBT individuals and racialized communities.
The MHCC explains that recovery-oriented approaches break down power imbalances between those with mental illness and treatment providers, and recognize the experiences, insights, and expertise of people living with mental illness.
Mental Health Foundation
The Mental Health Foundation, a non-profit organization in the U.K., describes the recovery process, which:
- “provides a holistic view of mental illness that focuses on the person, not just their symptoms
- believes recovery from severe mental illness is possible
- is a journey rather than a destination
- does not necessarily mean getting back to where you were before
- happens in ‘fits and starts’ and, like life, has many ups and downs
- calls for optimism and commitment from all concerned
- is profoundly influenced by people’s expectations and attitudes
- requires a well organised system of support from family, friends or professionals
- requires services to embrace new and innovative ways of working”
The Mental Health Foundation also identifies a number of factors that support recovery, including good relationships, financial security, satisfying work (it was not specified whether this was volunteer as well as paid), personal growth, the “right living environment” (although it doesn’t specify what this is), and developing resilience.
The U.S. government site MentalHealth.gov identifies four dimensions of mental health recovery: health, home, purpose, and community. The Substance Abuse and Mental Health Services Administration (SAMHSA) identifies ten guiding principles of recovery: respect, hope, person-driven, many pathways, holistic, peer support, relational, culture, addresses trauma, and strengths/responsibilities. Hop back across the Atlantic, and the Scottish Recovery Network uses the CHIME acronym to describe common themes of recovery: Connectedness, Hope and optimism, Identity, Meaning, and Empowerment.
What does it look like in practice?
Clearly multiple agencies in multiple countries are talking the talk of recovery-oriented practice, but does it actually mean anything? Does the real meaning of recovery get buried under these dimensions and principles and acronyms? And do the voices of those of us with mental illness get drowned out by the voices of those who want to tell us what recovery is?
I work in a concurrent disorders (mental health and addictions) program that has recovery right in the name. Yet I see precious little recovery in the implementation, and often considerable paternalism. The program leaders might know the language of recovery, but their decisions don’t show any real understanding. I think that in many ways, it’s even worse to be recovery-oriented in name only rather than not claiming a recovery orientation in the first place, because it contributes to misunderstanding of what recovery actually is. It becomes something that professionals hijack and take away from those of us living with these illnesses.
In some ways I’d prefer to set aside definitions of recovery entirely and say it’s whatever the individual living with the illness believes it is for them. I used to think that my own recovery would involve being symptom-free, but I’m not sure that’s realistic, so now I’m looking to be able to engage in meaningful activities that give me a sense of purpose.
What does mental illness recovery mean for you? What do you think of what the various organizations are saying about it?
- Mental Health Commission of Canada.(2009): Toward Recovery and Well-being: A Framework For a Mental Health Strategy For Canada
- Mental Health Commission of Canada (2015): Guidelines For Recovery-Oriented Practice
- Mental Health Foundation: Recovery
- MentalHealth.gov: Recovery is Possible
- Scottish Recovery Network: What helps
- Substance Abuse and Mental Health Services Administration (2012): SAMHSA’s Working Definition of Recovery
- Wikipedia: Recovery approach