The recovery model, recovery approach or psychological recovery is an approach to mental disorders or substance dependence that emphasizes and supports a person's potential for recovery. Recovery is generally seen in this model as a personal journey rather than a set outcome, and one that may involve developing hope, a secure base and sense of self, supportive relationships, empowerment, social inclusion, coping skills, and meaning. Recovery sees symptoms as a continuum of the norm rather than an aberration and rejects sane-insane dichotomy.
William Anthony, director of the Boston Centre for Psychiatric Rehabilitation, developed a cornerstone definition of mental health recovery in 1993. "Recovery is 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."
The concept of recovery in mental health emerged as deinstitutionalization led to more individuals living in the community. It gained momentum as a social movement in response to a perceived failure by services or wider society to adequately support social inclusion, coupled with studies demonstrating that many people do recover. A recovery-oriented approach has since been explicitly adopted as the guiding principle of mental health and substance dependency policies in numerous countries and states. Practical steps have been taken to base services on a recovery model, although obstacles, concerns, and criticisms have been raised by both service providers and recipients of services. Several standardized measures have been developed to assess different aspects of recovery, although there is some divergence between professionalized models and those originating in the psychiatric survivors movement.
History In general medicine and psychiatry, recovery has long been used to refer to the end of a particular experience or episode of illness. The broader concept of "recovery" as a general philosophy and model was first popularized in regard to recovery from substance abuse and drug addiction—for example, within twelve-step programs or the California Sober method.
Mental health recovery emerged in Geel, Belgium in the 13th century. Saint Dymphna—the patron saint of mental illness—was martyred there by her father in the 7th century. The Church of Saint Dymphna, built in 1349, became a pilgrimage destination for those seeking help with their psychiatric conditions. By the late 1400s, so many pilgrims were coming to Geel that the townspeople began hosting them as guests in their homes. This tradition of community recovery continues today. The remarkable story of Geel: 700 years of community-based mental health care
More widespread application of recovery models to psychiatric disorders is comparatively recent. The concept of recovery can be traced back as far as 1840, when John Thomas Perceval, son of Prime Minister Spencer Perceval, wrote of his personal recovery from the psychosis that he experienced from 1830 until 1832, a recovery that he obtained despite the "treatment" he received from the "lunatic" doctors who attended him.History of the Recovery Movement But by consensus the main impetus for the development came from within the consumer/survivor/ex-patient movement, a grassroots self-help and advocacy initiative, particularly within the United States during the late 1980s and early 1990s.Office of the Surgeon General and various United States Government agencies (1999) Mental Health: A report of the Surgeon General. Section 10: Overview of Recovery The professional literature, starting with the psychiatric rehabilitation movement in particular, began to incorporate the concept from the early 1990s in the United States, followed by New Zealand and more recently across nearly all countries within the "First World". Similar approaches developed around the same time, without necessarily using the term 'recovery', in Italy, the Netherlands and the UK.
Developments were fueled by a number of long-term outcome studies of people with "major mental illnesses" in populations from virtually every continent, including landmark cross-national studies by the World Health Organization from the 1970s and 1990s, showing unexpectedly high rates of complete or partial recovery, with exact statistics varying by region and the criteria used. The cumulative impact of personal stories or testimony of recovery has also been a powerful force behind the development of recovery approaches and policies. A key issue became how service consumers could maintain the ownership and authenticity of recovery concepts while also supporting them in professional policy and practice.
Increasingly, recovery became both a subject of mental health services research and a term emblematic of many of the goals of the consumer/survivor/ex-patient movement. The concept of recovery was often defined and applied differently by consumers/survivors and professionals. Specific policy and clinical strategies were developed to implement recovery principles although key questions remained.Jacobson, N. and Curtis, L. (2000) Recovery as Policy in Mental Health Services: Strategies Emerging from the States. Psychosocial Rehabilitation Journal, Spring
Elements of recovery It has been emphasized that each individual's journey to recovery is a deeply personal process, as well as being related to an individual's community and society.Repper, J. & Perkins, R. (2006) Social Inclusion and Recovery: A Model for Mental Health Practice. Bailliere Tindall, UK. A number of features or signs of recovery have been proposed as often core elements and comprehensively they have been categorized under the concept of CHIME. CHIME is a mnemonic of connectedness, hope & optimism, identity, meaning & purpose and empowerment.Leamy, M., Bird, V.J., Le Boutillier, C., Williams, J. & Slade, M. (2011). A conceptual framework for personal recovery in mental health: systematic review and narrative synthesis. British Journal of Psychiatry, 199:445-452.
Connectedness and supportive relationships 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. According to Relational Cultural Theory as developed by Jean Baker Miller, recovery requires mutuality and empathy in relationships. The theory states this requires relationships that embody respect, authenticity, and emotional availability. Supportive relationships can also be made safer through predictability and avoiding shaming and violence. While mental health professionals can offer a particular limited kind of relationship and help foster hope, relationships with friends, family and the community are said to often be of wider and longer-term importance.Hack Thyself (2012) Recovery Is Impossible Without Friends Case managers can play the role of connecting recovering persons to services to which the recovering person may have limited access, such as food stamps and medical care. Others who have experienced similar difficulties and are on a journey of recovery can also play a role in establishing community and combating a recovering person's feelings of isolation. An example of a recovery approach that fosters a sense of community to combat feelings of isolation is the safe house or transitional housing model of rehabilitation. This approach supports victims of trauma through a community-centered, transitional housing method that provides social services, healthcare, and psychological support to navigate through and past experiences. Safe houses aim to support survivors on account of their individual needs and can effectively rehabilitate those recovering from issues such as sexual violence and drug addiction without criminalization. Additionally, safe houses provide a comfortable space where survivors can be listened to and encouraged through compassion. In practice, this can be accomplished through one-on-one interviews with other recovering people, engaging in communal story circles, or participating in peer-led support groups. Those who share the same values and outlooks more generally (not just in the area of mental health) may also be particularly important. It is said that one-way relationships based on being helped can actually be devaluing and potentially re-traumatizing, and that reciprocal relationships and mutual support networks can be of more value to self-esteem and recovery.
Hope Finding and nurturing hope has been described as a key to recovery. It is said to include not just optimism but 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 pain.
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, while nurturing personal psychological space that allows room for developing understanding and a broad sense of self, interests, spirituality, and other concepts. It was suggested that the process is usually greatly facilitated by experiences of interpersonal acceptance, mutuality, and a sense of social belonging, and is often challenging in the face of the typical barrage of overt and covert negative messages that come from the broader social context. Being able to move on can mean having to cope with feelings of loss, which may include despair and anger. When an individual is ready for change, a process of grieving is initiated. It may require accepting past suffering and lost opportunities or lost time.
Formation of healthy coping strategies and meaningful internal schema The development of personal coping strategies (including self-management or self-help) is said to be an important element. This can involve making use of medication or psychotherapy if the patient is fully informed and listened to, including about adverse effects and about which methods fit with the consumer's life and their journey of recovery. Developing coping and problem solving skills to manage individual traits and problem issues (which may or may not be seen as symptoms of mental disorder) may require a person becoming their own expert, in order to identify key stress points and possible crisis points, and to understand and develop personal ways of responding and coping. Developing a sense of meaning and overall purpose 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