WARNING, this post talks about recovery and may be offensive to some for various reasons including a belief that recovery is beyond their capacity.

Recently, I came across a joint position paper about: A common purpose: Recovery in future mental health services http://www.scie.org.uk/publications/...apers/pp08.pdf

Two sections on recovery piqued my interest:

3.2 Defining recovery

There is not yet a succinct or universally accepted definition of recovery. In ordinary speech, recovery is often equated with cure, a return to how things were before the illness or injury occurred, a process of getting back to normal, but by this definition few, if any, who experience severe mental illness recover (Whitwell, 2005). However, for severe mental health problems, and in reality all long-term conditions, outcomes are more complex and are described both by resolution of symptoms, impacts on life domains affected by illness, and growth and development of other valued life experiences. Some professional definitions of recovery distinguish between ‘complete clinical recovery’, with total absence of symptoms, and ‘social recovery’, which means the ability to live a more or less independent life even if symptoms remain. The current concept of recovery includes both of these but has moved from professional definitions towards self-definition, such that the concept and experience of personal A common purpose recovery is not limited by the presence or absence of symptoms, and disabilities, nor the ongoing use of services. The concept of personal recovery pivots around considerations of how to live and how to live well in the context of long-term mental health conditions. How to develop a strong and satisfactory personal identity that is not defined by illness is a key issue, for example: ‘just because you have a diagnosis of schizophrenia doesn’t mean that you have to be a schizophrenic’. This way of thinking about recovery engages with the seemingly paradoxical assertion that you can be well even if you have a long-term illness, or as the Stanford University selfmanagement course put it, ‘Living a healthy life with chronic conditions’ (Cooper and Clarke, 2005).

Thus recovery has been defined as, ‘a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and roles. It is a way of living a satisfying, hopeful, and contributing life even with limitations caused by the 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, 1993).

Based on her personal experience, Deegan (1988) defines recovery as, ‘a process, a way of life, an attitude, and a way of approaching the day’s challenges’. The recovery literature (Allott et al, 2002; Ralph and Corrigan, 2005) similarly describes being in recovery as an ongoing process, which involves gaining or regaining many aspects of life that are usually taken for granted, and may be lost or severely compromised by mental illness. Recovery may involve many stages, and inevitably setbacks and uncertainty, and has been described as, ‘an uncharted, unpredictable, and personal journey’ (Antony Sheehan, preface to the National Institute for Mental Health in England (NIHME) Inspirations, a calendar of recovery, 2002).

The American Psychiatric Association’s position statement, ‘endorsing and strongly affirming the application of the concept of recovery’, gathered many of these viewpoints and emphasised that recovery-based practice is based on broad partnerships that seek to uphold hope and maximise quality of life:

The concept of recovery emphasises a person’s capacity to have hope and lead a meaningful life, and suggests that treatment can be guided by attention to life goals and ambitions. [The recovery approach] recognizes that patients often feel powerless or disenfranchised, that these feelings can interfere with initiation and maintenance of mental health and medical care, and that the best results come when patients feel that treatment decisions are made in ways that suit their cultural, spiritual, and personal ideals. [The recovery approach] focuses on wellness and resilience and encourages patients to participate actively in their care, particularly by enabling them to help define the goals of psychopharmacologic and psychosocial treatments.… The application of the concept of recovery requires a commitment to a broad range of necessary services and should not be used to justify a retraction of resources. (APA, 2005)

The issue of definition and personal redefinition, in particular from being chronically ill to ‘in recovery’, lies at the heart of a recovery-based approach to long-term conditions. The meanings that are attributed to experiences and the stories that are told about them assume a particular importance in confirming illness or supporting wellness. There is also a shift of emphasis from clinical and social recovery to personal recovery, as valued and defined by the individual.

Recovery is the process of regaining active control over one’s life. This may involve discovering (or rediscovering) a positive sense of self, accepting and coping with the reality of any ongoing distress or disability (Faulkner and Layzell, 2000) finding meaning in one’s experiences, resolving personal, social or relationship issues that may contribute to one’s mental health difficulties, taking on satisfying and meaningful social roles, and calling on formal and/or informal systems of support as needed (Leibrich, 1999). Services can be an important aspect of recovery but the extent of the need for services will vary from one person to another. For some people, recovery may mean exiting from mental health services either permanently or for much of the time. For others it may mean continuing to receive ongoing forms of medical, personal or social support that enable people to get on with their lives.

3.3 Themes in recovery

Engaging with a move towards recovery-based practice takes in far wider considerations than familiar concerns about giving or receiving effective treatment. It is about engaging with the complexities of lived experience and seeking to constructively support an increased possibility of recovery outcomes. The recovery literature has arisen largely from personal experience with more recognisably scientific evaluation and theory following later, and although rich in personal meaning it remains light on systematic analysis. The dynamics and essential components of the recovery process have yet to be fully understood or evaluated but the process of recovery has been recurrently associated with a number of core themes (Deegan, 1988; Onken et al, 2002; Turner-Crowson and Wallcraft, 2002;
Allott, 2005; Ralph and Corrigan, 2005; Roberts and Wolfson, 2006). Taken together, these themes do not so much define recovery as sketch out the map on which recovery journeys are lived, and suggest directions for research, evaluation and the development of recovery-based practice and services.

Key themes include the following:

1 . Recovery is fundamentally about a set of values related to human living applied to the pursuit of health and wellness.
2 . Recovery involves a shift of emphasis from pathology, illness and symptoms to health, strengths and wellness.
3 . Hope is of central significance. If recovery is about one thing it is about the recovery of hope, without which it may not be possible to recover and that hope can arise from many sources, including being believed and believed in, and the example of peers.
4. Recovery involves a process of empowerment to regaining active control over one’s life. This includes accessing useful information, developing confidence in negotiating choices and taking increasing personal responsibility through effective self-care, self-management and self-directed care.
5. Finding meaning in and valuing personal experience can be important, as is personal faith for which some will draw on religious or secular spirituality.
6. Recognising and respecting expertise in both parties of a helping relationship which recontextualises professional helpers as mentors, coaches, supporters, advocates and ambassadors.
7. Recovery approaches give positive value to cultural, religious, sexual and other forms of diversity as sources of identity and belonging.
8. Recovery is supported by resolving personal, social or relationship problems and both understanding and realistically coming to terms with ongoing illness or disability.
9. People do not recover in isolation. Recovery is closely associated with social inclusion and being able to take on meaningful and satisfying social roles in society and gaining access to mainstream services that support ordinary living such as housing, adequate personal finances, education and leisure facilities.
10. There is a pivotal need to discover (or rediscover) a positive sense of personal identity, separate from illness and disability.
11 . The language used and the stories and meanings that are constructed around personal experience, conveyed in letters, reports and conversations, have great significance as mediators of recovery processes. These shared meanings either support a sense of hope and possibility or carry an additional weight of morbidity, inviting pessimism and chronicity.
12 . Services are an important aspect of recovery but the value and need for services will vary from one person to another. For some people, recovery is equated with detaching from mental health services either permanently or for much of the time. For others, recovery may be associated with continuing to receive ongoing forms of medical, personal or social support that enable them to get on with their lives.
13 . Treatment is important but its capacity to support recovery lies in the opportunity to arrive at treatment decisions through negotiation and collaboration and it being valued by the individual as one of many tools they choose to use.
14. The development of recovery-based services emphasises the personal qualities of staff as much as their formal qualifications, and seeks to cultivate their capacity for hope, creativity, care and compassion, imagination, acceptance, realism and resilience.
15. In order to support personal recovery, services need to move beyond the current preoccupations with risk avoidance and a narrow interpretation of evidence-based approaches towards working with constructive and creative risk-taking and what is personally meaningful to the individual and their family.

The concept of recovery has been talked about before at length here. Objective views on what constitutes recovery are going to be controversial. Who is going to be making the decision about whether someone is recovered?

The healthcare provider will want a lower standard of recovery since a more stringent one will mean the provider must continue to provide benefits. Big Pharma may have a different view since recovery is not profitable. The politicos view those with illnesses as budget items.

What about the consumer? The model talks about empowering consumers subjectively to define their own recovery. The question remains whether the consumers will be allowed to. If the healthcare providers and our concerned representatives stop the funding, who really is deciding who has recovered?