Recovery

NIMHE Guiding Statement
on Recovery

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This section of the website provides specific information about recovery. Unlike many other models and accounts of mental distress the thing that is unique to the ‘recovery movement’ is that its development has been user led, and not academically or professionally led. Thus the principles underpinning recovery directly relate back to the many personal narratives and stories written by service users (who sometimes refer to themselves as survivors, patients, consumers and so on) about their own experiences and how they have recovered.

What is Recovery?

In the introduction to the 'Emerging Best Practices in Recovery' poster Anthony Sheehan, Director of Care Services, Department of Health wrote:

In establishing NIMHE (now called CSIP) I was mindful of the importance of ‘recovery’ and the fact that at its core is people who have been diagnosed as ‘mentally ill ‘taking back control over their lives’…now a central element of Government Policy ‘putting the user at the centre of everything we do’. Recovery is the practice of values and I see it as the ‘How’ of service delivery.”

So Recovery is the ‘How’ of service delivery. Let us explore what this means. Below are the Guiding Principles that are set out in the Recovery Poster:

Principle I

The user of services decides if and when to begin the recovery process and directs it; therefore, service user input is essential throughout the process.

Principle II

The Mental Health System must be aware of its tendency to promote service user dependency.

Principle III

Users of service are able to recover more quickly when their:

• Hope is encouraged, enhanced and/or maintained;
• Life roles with respect to work and meaningful activities are defined;
• Spirituality is considered;
• Culture is understood;
• Educational needs as well as those of families/significant others are identified;
• Socialisation needs are identified;
• They are supported to achieve their goals.

Principle IV

Individual differences are considered and valued across the life span.

Principle V

Recovery from mental illness is most effective when a holistic approach is considered; this includes psychological, emotional, spiritual, physical and social needs.

Principle VI

In order to reflect current “best practices” there is a need for an integrated approach to treatment and care that includes Medical/biological, Psychological, Social, Values Based and Recovery approaches.

Principle VII

Clinicians and practitioners initial emphasis on “hope” and the ability to develop trusting relationships influences the recovery of users of services.

Principle VIII

Clinicians and practitioners should operate from a strengths/assets model.

Principle IX

Clinicians, practitioners and users of service should collaboratively develop a recovery management or wellness recovery action plan. This plan focuses on wellness, the treatments and supports that will facilitate recovery and the resources that will support the recovery process.

Principle X

Involvement of a person’s family, partner and friends may enhance the recovery process. The user of service should define whom they wish to involve.

Principle XI 

Mental Health services are most effective when delivery is within the context of the service users locality and cultural context.

Principle XII  

Community involvement as defined by the user of service is central to the recovery process.

There is also an Emerging National Framework of Values for Mental Health

The three principles of values-based practice are:

1. Recognition CSIP recognises the role of values alongside evidence in all areas of mental health policy and practice.
2. Raising Awareness CSIP is committed to raising awareness of the values involved in different contexts, the role/s they play and their impact on practice in mental health.
3. Respect - CSIP respects diversity of values and will support ways of working with such diversity that makes the principle of service user-centrality a unifying focus for practice. This means that the values of each individual user of services and their professionals.

Respect for diversity of values encompasses a number of specific policies and principles concerned with equality of citizenship. In particular, it is anti-discriminatory because discrimination in all its forms is intolerant of diversity. Thus, respect for diversity of values has the consequence that it is unacceptable (and unlawful in some instances) to discriminate on grounds such as gender, sexual orientation, class, age, abilities, religion, race, culture or language.

Respect for diversity within mental health is also:

• user-centred - it puts respect for the values of individual users at the centre of policy and practice
• recovery oriented – it recognises that building on the personal strengths and resilience’s of individual users, and on their cultural and racial characteristics, there are many diverse routes to recovery
• multi-disciplinary - it requires that respect be reciprocal, at a personal level (between service users, their family members, friends, communities and providers), between different provider disciplines (such as nursing, psychology, psychiatry, medicine, social work, occupational therapy), and between different organisations (including health, social care, local authority housing, voluntary organisations, community groups, faith communities and other social support services)
• dynamic - it is open and responsive to change
• reflective - it combines self-monitoring and self-management with positive self regard
• balanced - it emphasises positive as well as negative values
• relational - it puts positive working relationships supported by good communication skills at the heart of practice

CSIP will encourage educational and research initiatives aimed at developing the capabilities (the awareness, attitudes, knowledge and skills) needed to deliver mental health services that will give effect to the principles of values-based practice.

Recovery has been defined as:

“….. a process, a way of life, an attitude, and a way of approaching the day’s challenges. It is not a perfectly linear process. At times our course is erratic and we falter, slide back, regroup and start again . . . .The need is to meet the challenge of the disability and to re-establish a new and valued sense of integrity and purpose within and beyond the limits of the disability; the aspiration is to live, work, and love in a community in which one makes a significant contribution.”

(Deegan, 1988, p. 15). [10]

“Having some hope is crucial to recovery; none of us would strive if we believed it a futile effort . . .I believe that if we confront our illnesses with courage and struggle with our symptoms persistently, we can overcome our handicaps to live independently, learn skills, and contribute to society, the society that has traditionally abandoned us.”

(Leete, 1989).

“…..enabling people with mental health problems to maintain or rebuild valuable and satisfying lives within and beyond the limits imposed by their difficulties”

Repper and Perkins (2003) [76]

The Importance of Hope

According to Repper and Perkins (2003) if mental health workers are to inspire hope and promote recovery, then three interrelated components are central. These are:

• Developing hope-inspiring relationships
• Facilitating personal adaptation: understanding, acceptance and taking back control
• Promoting inclusion: helping people to access the roles, relationships and activities that are important to them

Developing Hope-Inspiring Relationships

It is the right of all service users and carers to expect that all contacts with mental health workers is geared towards promoting hope. The availability of specific therapy skills is of course important – especially cognitive behavioural approaches – but without the ability to foster hope, to demonstrate a positive and optimistic attitude then whether one has such skills is largely irrelevant – as the message received by service users will be one of pessimism and hopelessness for the future .

In building hope-inspiring relationships mental health workers must genuinely value and accept people for what they are; see and believe in their potential and abilities; listen to, accept and actively explore their experiences; tolerate uncertainty about the future; and help them to build on the problems and set-backs that will be part of their recovery processes. It involves a willingness to persevere and continue believing in someone even when everything seems to be going wrong, coupled with a genuine empathy and concern for their well-being, and a measure of humour – laughing with (not at or about) that person.

Repper and Perkins (2003) [76]

Facilitating personal adaptation : understanding, acceptance and taking back control

It is not necessary for the person experiencing psychosis to accept the diagnosis given to them by their doctor in order for them to recover. What is important is that the mental health worker can help the person come to a shared understanding that is acceptable to their own social and cultural background, that takes into account their needs and aspirations and helps them to take back control of decisions that affect their recovery.

Promoting inclusion: helping people to access the roles, relationships and activities that are important to them

People who experience problems with their mental health want to maintain or rebuild satisfying lifestyles in much the same way as any other person in their local communities. For mental health workers this may mean the person requires help to access material resources (money, housing, decent clothing, possessions, etc.), assistance with maintaining existing roles and relationships and/or help to develop new ones, and facilitating engagement in valued activities. Repper and Perkins (2003) contest that it is these three dimensions of hope-inspiring competence that lie at the heart of a model for mental health practice that can facilitate recovery. They warn however, that these should not form a set formula or sequence. Each individual person has different and unique needs and therefore requires a unique and individual approach taken with them. [76]