Unfortunately, mental health professionals are a major source of stigma towards people with mental illness. Recovery-oriented practice is one possibility for transforming mental health care into a less stigmatizing place, so let’s talk about what that might look like.
What recovery is
Personal recovery, also known as psychosocial recovery, is a different can of tuna from the remission of symptoms of illness. Remission is a clinical term that refers specifically to illness symptoms; as examples, you can find definitions of remission here for depression, bipolar, and schizophrenia.
Rethink Mental Illness uses this definition of recovery from Anthony (1993):
Recovery is described as a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills, and/or roles. It is a way of living a satisfying, hopeful, and contributing life even with 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 also explains that recovery is more than just recovering from the illness itself; it can also involve recovery from stigma, negative experiences of treatment, and loss of opportunities, and recovery from those things may actually be more difficult than dealing with the illness itself. Recovery isn’t something mental health professionals do to/for a patient; they can only support patients as they forge their own paths and determine what their own version of recovery is going to look like.
Recovery is about the process rather than being something that’s measured in terms of outcomes, and that process can happen even if symptoms are ongoing. However, I don’t think that stops a lot of people from talking about it as if it’s an outcome that involves freedom from illness. I’ve written before about my concerns about “recovery is a choice” messaging, and I think there’s a problem when people start to expect some endpoint of recovery rather than accepting that different people may be at very different places in their illness/recovery journeys.
What recovery-oriented practice is
Recovery-oriented practice looks different from traditional mental health care practice in a number of ways. It emphasizes:
- personal meanings and purpose for the individual with mental illness
- developing a positive identity and valued social roles
- recognizing people with mental illness as experts by experience
- focusing on the person rather than the disorder
- care is adapted to the individual rather than the other way around
- transformation rather than a return to normal
The Mental Health Commission of Canada has published Guidelines for Recovery-Oriented Practice. According to these guidelines, “A key source of hope comes from looking beyond the challenges that may accompany illness to see people’s unique strengths, character, innate abilities and potential for growth.”
They add: “Recovery is nurtured by working with people to help activate their internal resources so they are able to retain and deepen a belief in their abilities, strengthen their sense of personal agency and acquire control over their journey of recovery and well-being.” The focus is on strengths and what people can do rather than their limitations and barriers.
How this relates to stigma
Stigma among health professionals often involves stereotypes related to incompetence, leading to the belief that health care providers need to take a paternalistic role. Other common issues include pessimism around recovery, seeing the illness rather than the person, and having an us vs. them mindset that frames patients as being fundamentally different from health care providers.
Recovery-oriented practice turns a lot of that on its head. The basic principles, like hope, empowerment, and choice, really aren’t compatible with stigma. While stigma is about stereotypes, recovery-oriented practice is about seeing individuals as unique beings that have strengths rather than just weaknesses. It’s a shift in attitude that’s a change in the right direction if we’re going to be able to stop the stigma in mental health care.
Getting it right
However, to go in that right direction, attitudes actually have to change. Lip service to recovery does nothing to reduce stigma, and it may be used as an excuse for health care providers not to engage in self-reflection around the impact of their own practices. An attitude of “there can’t be stigma because we’re recovery-oriented” doesn’t help anyone.
My last nursing job was at a facility that claimed to be recovery-oriented. It was even in their name, but it was hypocritical bullshit. The whole program operated in an incredibly paternalistic manner, and a lot of the staff had some pretty crappy attitudes. There was stigma up the ying yang when it came to patients with borderline personality disorder. It was a perfect example of lip service to recovery that was just an excuse for shitty practice, and it was a pretty yucky place to work as a result.
Actual recovery-oriented practice, on the other hand, could make a big difference. I think that the only way to ensure high-fidelity implementation is to have people with mental illness involved in the implementation and evaluation. Unfortunately, far too many of the people in power don’t get there by being committed to truly helping people with mental illness. I would like to hope that that’s a quirk of the system where I’ve worked, but I doubt it. Recovery-oriented practice can’t be successfully implemented by people who are riding high on their own power trips.
Does recovery-oriented practice sound like something you think would be helpful? Do you see it as something that could successfully be implemented throughout the mental health care system, or is that just a pipe dream?
- Anthony, W. A. (1993). Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. Psychosocial Rehabilitation Journal, 16(4), 11-23.
- Mental Health Commission of Canada:
- Rethink Mental Illness: 100 Ways to Support Recovery