Recovery: an international perspective

Abstract

SummaryAims– To review developments in recovery-focussed mental health services internationally.Methods– Two forms of ‘recovery’ which have been used in the literature are considered, and international examples of recovery-focussed initiatives reviews. A ‘litmus test’ for a recovery-focussed service is proposed.Results– ‘Clinical recovery’ has emerged from professional literature, focuses on sustained remission and restoration of functioning, is invariant across individuals, and has been used to establish rates of recovery. ‘Personal recovery’ has emerged from consumer narratives, focuses on living a satisfying, hopeful and contributing life even with limitations caused by the illness, varies across individuals, and the empirical evidence base relates to stages of change more than overall prevalence rates. Clinical and personal recovery are different. Two innovative, generalisable and empirically investigated examples are given of implementing a focus on personal recovery: the Collaborative Recovery Model in Australia, and Trialogues in German-speaking Europe. The role of medication is an indicator: services in which all service users are prescribed medication, in which the term ‘compliance’ is used, in which the reasoning bias is present of attributing improvement to medication and deterioration to the person, and in which contact with and discussion about the service user revolves around medication issues, are not personal recovery-focussed services.Conclusions– The term ‘Recovery’ has been used in different ways, so conceptual clarity is important. Developing a focus on personal recovery is more than a cosmetic change – it will entail fundamental shifts in the values of mental health services.Declaration of Interest: None.

Do clinical outcome measures assess consumer-defined recovery?

“…On the other hand, little relationship was found between traditional clinical measures of outcome and the consumer-oriented measures of recovery, demonstrating the conceptual difference between "personal recovery" and "clinical recovery" (Slade et al, 2008).…”

“…Mental health consumers with enduring mental illnesses, such as schizophrenia and bipolar disorder, have been advocating for some time that services should be recovery-oriented, and this goal is being incorporated internationally into mental health policy, predominantly in the English speaking world (Slade et al, 2008). 'Recovery', as used by mental health consumer advocates, differs from the commonly-held meaning of the returning to a previous level of health and functioning after illness.…”

“…They refer to the establishment of a meaningful and fulfilling life, a positive sense of identity and taking responsibility for one's own wellbeing (e.g. Anthony, 1993;Andresen et al, 2003;Resnick et al, 2005;Slade et al, 2008).…”

A recovery journey for people with personality disorder

“…Slade et al (2008) identify two classes of meanings. First is the traditional concept of recovery as cure.…”

Peer Support in a Mental Health Service Context

“…That is, it is not sufficient to conceptualise peer support initiatives only at the individual level and assess the benefits and the psychological and functioning of the indivdiual. Peer support initiatives should also be investigated as to how they lead to organisational transformation of culture, and how they interface with the policy related to recovery oriented service provision (Slade, Amering, & Oades, 2008). The following is a brief example of a peer support service provided by a psychosocial rehabilitation service in Australia that attempts to addresses some of the organisational issues that arise.…”