Jaime Essed, Founder and CEO of the company Oh My Mood, turns the spotlight onto Recovery-focused mental healthcare
In traditional healthcare, the term ‘recovery’ mostly has been used to refer to the end of a particular experience or episode of illness. From the biomedical perspective, health was regarded as a state of normal functioning that could be disrupted from time to time by disease. Recovery comprised the restoration of the body’s ability to function, with full symptom-remission as a set outcome. However, in recovery-focused mental healthcare, ‘recovery’ covers a broader concept. The term does not refer to a set outcome of full symptom-remission, but to “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 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”. Developed in 1993 by William Anthony, Director of the Boston Center for Psychiatric Rehabilitation, this definition of mental health recovery, has become one of the cornerstones of the recovery concept.
Central to the concept is that individuals with severe mental illness want and need more than just symptom relief. It also made clear that, when isolated from subjective experience, symptoms are inadequate to qualify personal mental health. Although it is a fact that severe mental illness causes symptoms or mental impairments that can generate significant functional limitations, disabilities and handicaps, it has also been proven a fact that people can grow beyond the effects of mental illness. As the person moves on to other interests and activities they are no longer the primary focus of one’s life. Successful recovery means that the person has changed his or her focus toward living a satisfying, hopeful and contributing life even with the limitations caused by the illness.
The main impetus for the development of the recovery concept came from the consumer/survivor/ex-patient movement during the late 1980s and early 1990s in the United States (U.S.). The main message was that there is no need nor right in approaching individuals with severe psychiatric disabilities as incomplete or failed and unnecessarily isolate or exclude them from society. Instead, they should be empowered to develop their potentials to meet their needs, wants and responsibilities and assert their rights to full citizenship as any other citizen. Be it quite slowly, the implications of this message for the mental health system became better understood. How service users could maintain the ownership and authenticity of their recovery while also supporting them in professional policy and practice currently has become a key issue in the mental health system of many countries.
Often, those with lived experience have described recovery as the journey of an individual as they grow within and beyond what has happened. Recovery is a personal journey in which individuals do not define themselves in relation to their symptoms and the mental healthcare services but in relation to their own life. During this journey, the patient develops a secure base and sense of self from which they can find new meaning in life and build coping skills and supportive relationships and social roles. This process is not linear but does tend to take place as a series of small steps, which can be continued even if symptoms later re-occur. The overarching message is that hope and restoration of a meaningful life are possible, despite serious mental illness. In this journey, it is not the professional who takes centre stage. This person may (or may not) have a marginal role.
Although recovery has emerged from the lived experience of people experiencing what professionals understand as mental illness, scientific research is catching up in its ability to validate the assertions of service users and their families. The professional literature began to incorporate the recovery concept from the early 1990s in the U.S. Fuelled by a number of long-term outcome studies of people with “major mental illnesses” in populations from virtually every continent, including landmark cross-national longitudinal studies by the World Health Organization (WHO) in the 1970s and 1990s showing unexpectedly high rates of complete or partial recovery, it became clear that the population of people who are professionally seen in mental health services does not offer a representative picture of life following a diagnosis of mental health problems.
Based on growing empirical evidence, mental health services are increasingly focused on supporting long-lasting positive change in patients’ lives and promote well-being through strengthening positive psychosocial characteristics in people who suffer from or are at high risk of developing mental or physical illnesses. From fixing what’s wrong to building what’s strong became the credo under which flag professionals take their (modest) part in building resilience, optimism, personal mastery and coping self-efficacy, social engagement, spirituality and religiosity and wisdom (including compassion). A growing body of research shows that higher levels of these characteristics are associated with objectively measured better health outcomes including greater longevity, as well as with overall subjective well-being.
In general, recovery may be seen as more of a philosophy or attitude than a specific model, requiring fundamentally that people with mental illness regain personal power and a valued place in the community. Even when they sometimes need services to support them to get there, this doesn’t mean that they should be silenced and cut off from their personal needs and wishes, or even from their personal wisdom. Recovery needs to address the whole of people’s lives and to encourage aspirations while promoting equal access and opportunities within society.
It has been emphasised that each individual’s journey to recovery is a deeply personal process, though being firmly related to an individual’s community and society. A number of features or signs of recovery have been proposed as core elements and have been categorised under the concept of CHIME. CHIME is an abbreviation of Connectedness, Hope and optimism, Identity, Meaning & purpose and Empowerment and building a secure base.
Connectedness
A common aspect of recovery is said to be the presence of others who believe in the person’s potential to recover and who stand by them. Since mental health professionals can only offer a particular and limited kind of relationship, relationships with friends, family and the community are of wider and longer-term importance. Others who have experienced similar difficulties, who may also be on a journey of recovery, can be of particular importance. Since recovery is not synonymous with a cure, a strong supportive network is required. It is said that one-way relationships based on being helped can actually be devaluing and that reciprocal relationships and mutual support networks can be of more value to self-esteem and recovery.
Hope and optimism
Finding and nurturing hope has been described as a key to recovery. Hope doesn’t include just optimism, but represents a sustainable belief in oneself and a willingness to persevere through uncertainty and setbacks. Hope may start at a certain turning point, or emerge gradually as a small and fragile feeling and may fluctuate with despair. It is said to involve trusting and risking disappointment, failure and further hurt.
Identity
Recovery of a durable sense of self (if it had been lost or taken away) has been proposed as an important element. A research review suggested that people sometimes achieve this by “positive withdrawal” – regulating social involvement and negotiating public space in order to only move towards others in a way that feels safe yet meaningful and; nurturing personal psychological space that allows room for developing understanding and a broad sense of self. This process is usually greatly facilitated by experiences of interpersonal acceptance, mutuality and a sense of social belonging; and is often challenged by the overt and covert negative messages that come from the broader social context.
Meaning and purpose
Developing a sense of meaning and overall purpose in life is said to be important for sustaining the recovery process. This may involve recovering or developing a social or work role. It may also involve renewing, finding or developing a guiding philosophy, religion, politics or culture. From a postmodern perspective, this can be seen as developing a narrative.
Empowerment and building a secure base
For many, recovery has a personal as well as a political implication. Where to recover is to validate the self and find meaning; challenge prejudice (including diagnostic “labels” in some cases) and reclaim a chosen life and place within society. Recovery can, thus, be viewed as one manifestation of empowerment and self-determination to reduce the social and psychological effects of stress, develop the confidence for independent assertive living and building a positive culture of healing, overcoming social stigma and prejudice about mental disorder/difference and achieving social inclusion. This may require recovering detached social skills and identity, making up for gaps in work history for better self-management, etc. It has been suggested that essential in the recovery approach are appropriate housing, sufficient income, freedom from violence and adequate access to healthcare. An empowerment model may emphasise that conditions are not necessarily permanent; that “symptoms” can be understood as expressions of distress related to emotions and other people and that other people have recovered who can be role models and share experiences.
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Jaime Essed
Founder and CEO
Oh My Mood
Tel: + 44 (0)330 8382 554
