What is recovery? I think recovery means hope which leads a person to cure.
Principles The principles of recovery-oriented mental health practice ensure that mental health services are delivered in a way that supports the recovery of mental health consumers.
They are:
1. Uniqueness of the individual recognises that recovery is not necessarily about cure but is about having opportunities for choices and living a meaningful, satisfying and purposeful life, and being a valued member of the community accepts that recovery outcomes are personal and unique for each individual and go beyond an exclusive health focus to include an emphasis on social inclusion and quality of life empowers individuals so they recognise that they are at the centre of the care they receive.
2. Real choices supports and empowers individuals to make their own choices about how they want to lead their lives and acknowledges choices need to be meaningful and creatively explored supports individuals to build on their strengths and take as much responsibility for their lives as they can ensures that there is a balance between duty of care and support for individuals to take positive risks and make the most of new opportunities.
3. Attitudes and rights involves listening to, learning from and acting upon communications from the individual and their carers about what is important to the individual promotes and protects an individual’s legal, citizenship and human rights supports individuals to maintain and develop social, recreational, occupational and vocational activities which are meaningful to them instils hope in an individual about their future and ability to live a meaningful life.
4. Dignity and respect involves being courteous, respectful and honest in all interactions involves sensitivity and respect for each individual, especially for their values, beliefs and culture challenges discrimination wherever it exists within our own services or the broader community.
5. Partnership and communication acknowledges that each individual is an expert on their own life and that recovery involves working in partnership with individuals and their carers to provide support in a way that makes sense to them values the importance of sharing relevant information and the need to communicate clearly involves working in positive and realistic ways with individuals and their carers to help them realise their own hopes, goals and aspirations.
Individuals and their carers can track their own progress. Services demonstrate that they use the individual’s experiences of care to inform quality improvement activities. The mental health system reports on key outcomes that indicate recovery. These outcomes include housing, employment, education, social and family relationships, health and well being.
Change in recovery system or development
Anthony (1993) introduced recovery as the guiding vision for the mental health system after reading and listening to consumers’ personal accounts of their struggle through, and recovery from, mental illness. He traces the progress of the mental health system from the era of deinstitutionalization through the establishment of community support and rehabilitation Many mental health systems are now incorporating recovery into their state’s planning initiatives (Emery, Glover & Mazade, 1998). A number of states have included the word recovery or the concept of recovery in documents such as mission statements, guiding principles or descriptions of treatment programs. Some states are trying to incorporate recovery into the way mental health services are provided.
Many mental health systems are now incorporating recovery into their state’s planning initiatives (Emery, Glover & Mazade, 1998). A number of states have included the word recovery or the concept of recovery in documents such as mission statements, guiding principles or descriptions of treatment programs. Some states are trying to incorporate recovery into the way mental health services are provided.
In a report prepared for the Wisconsin Blue Ribbon Commission on Mental Health Care, Jacobson (1998) reports the findings of semi-structured telephone interviews conducted with key staff in 12 states, asking about how they operationalized and implemented recovery in their state mental health system. Jacobson obtained her sample by identifying states that were purported to be leaders in this area, and was referred to others through a snowball sampling process. She indicated that states are at different stages in planning and implementation, and that approaches to incorporating recovery differ from state to state. “Some states seem to be repackaging their old service models (e.g. CSPs, supported education, rehabilitation services) using the recovery language; others are wholly re- inventing themselves”
In a summary of this study, Jacobson and Curtis (2000) describe the process taken by states to develop a “recovery-oriented” service system and the areas or strategies selected to do this. The process is described as an effort to understand the concept and to determine its viability and value within clinical and financial constraints. The development of a vision statement is often done through the establishment of a task force or work group that includes diverse stakeholders. Multiple sources of information are tapped to assist in the understanding of the concept and the development of a vision statement. These processes incorporate a working definition of recovery and make recommendations to implement the principles identified. Jacobson and Curtis (2000) comment:
With vision statements in hand, some states simply rename their existing programs: Community support services, vocational rehabilitation or housing support are now described as ‘recovery-oriented’ services. This renaming process demonstrates a lack of understanding of recovery; in particular, a failure to acknowledge the necessity for a fundamental shift toward sharing both power and responsibility.
Strategies to implement and operationalize recovery in the mental health system in those states that have moved beyond the service renaming stage include “education, consumer and family involvement, support for consumer operated services, emphasis on relapse prevention and management, incorporation of crisis planning and advance directives, innovations in contracting and financing mechanisms, definition and measurement of outcomes, review and revision of key policies, and stigma-reduction initiatives” (Jacobson & Curtis, 2000,)
Jacobson and Curtis (2000) conclude their article on recovery and systems change with some very important and thought provoking questions about recovery and how, or whether, it should be incorporated into the mental health system. These comments are included in total here, because they speak to the major challenges that must be faced by individuals and systems as recovery is studied and programs and systems attempt to implement and operationalize a recovery orientation.
1. How can we deepen our understanding of recovery as an individual process? What stimulates and sustains the process? What hinders or smothers it? What are the best methods for answering such questions? 2. Can recovery be measured? Should recovery me measured? What are the risks of doing so? Of not doing so?
3. How can we transfer our knowledge about recovery as an individual process to our policy-making and service planning activities? How do specific policies and services affect individual recovery? 4. How will we know we are creating a recovery-oriented system? By what criteria should the system be judged? Should we measure individual gains? Aggregate outcomes? System-level change? Over what period of time?
5. How can we balance recovery as an individual, singular process, with the system’s need for standardization? Can we formulate a generalized concept of recovery and still respect the process as unique? 6. For what should we hold the system accountable? Are we willing to trade off some system liability for the increased self-determination and personal responsibility that seem to be the hallmark of recovery? 7. What barriers stand in the way of implementing a recovery orientation? What forces sustain the status quo? 8. Should recovery be the foundational principle of the mental health system?
These problems start with problems of epistemology – how best to study and measure recovery. But they end in problems of politics and values – what is to be our society’s approach to helping persons with psychiatric disabilities? For recovery to herald a real change in our assumptions and practices, and to make a difference in the lives of people living with severe and persistent mental illness, it is vital that all of these questions be engaged. How we choose to answer them will shape mental health services in the coming decades. (Jacobson and Curtis, 2000,)
