Who Mental Health Recovery Model

Recovery model - Recovery model

The Recovery model , the Recovery Approach or the psychological recovery is an approach to the treatment of mental disorders or substance addiction that highlights and supports a person's recovery potential. Recovery in this model is generally viewed as a personal journey rather than a set outcome that can include the development of hope, a secure base and self-esteem, supportive relationships, empowerment, social inclusion, coping skills, and meaning. Recovery sees symptoms as a continuum of the norm rather than an aberration and rejects a reasonable dichotomy.

William Anthony, director of the Boston Center for Mental Health Rehabilitation, came up with a curious definition of mental health recovery in 1993. "Recovery is a deeply personal, unique process in which attitudes, values, feelings, goals, skills, and / or roles are changed is a way to live a satisfying, hopeful, and contributing life, even when the illness is caused by limitation Recovery involves developing a new purpose in life as one grows beyond the disastrous effects of mental illness. "

The use of the concept of mental health occurred when deinstitutionalization resulted in more people living in the community. It gained momentum as a social movement because the services or society found it inadequate to adequately support social inclusion and studies showing that many people are recovering. A recovery approach has now been explicitly adopted as the guiding principle of mental health or substance addiction policies in a number of countries and states. In many cases, practical steps are taken to base services on a recovery model, despite a number of obstacles, concerns, and criticisms raised by both service providers and service recipients. A number of standardized measures have been developed to assess aspects of recovery, although there are some differences between professionalized models and those derived from the movement of psychiatric survivors.


In general medicine and psychiatry, recovery has long been used to denote the end of a particular experience or episode of illness. The broader concept of "recovery" as a general philosophy and model was first popularized with regard to recovery from substance abuse / addiction, for example in twelve-step programs.

The application of recovery models to psychiatric disorders is comparatively new. The concept of recovery can be traced back to 1840 when John Perceval, son of a British Prime Minister, wrote of his personal recovery from the psychosis he experienced from 1830 to 1832, a recovery he received despite "treatment" " received from the "crazy" doctors who came to see him, but by consensus the main impetus for development came from the consumer / survivor / ex-patient movement, a community-based self-help and advocacy initiative, particularly in the United States the late 1980s and early 1990s In the literature, particularly with the psychiatric rehabilitation movement, the concept was adopted in the United States from the early 1990s, followed by New Zealand and, more recently, in almost all "First World" countries. Similar approaches developed at about the same time in Italy, the Netherlands and the United Kingdom, without unconcern dings to use the term recreation.

Developments have been driven by a series of long-term studies of people with "severe mental illness" in populations from nearly every continent, including landmark World Health Organization cross-border studies from the 1970s and 1990s that showed unexpectedly high graduation rates or partial recovery, with the exact statistics vary depending on the region and criteria used. The cumulative impact of personal stories or testimonies of recovery has also been a powerful force in developing recovery approaches and strategies. A central theme became how service consumers can preserve the ownership and authenticity of recovery concepts while at the same time supporting them in their professional policy and practice.

Increasingly, recovery has become both the subject of research in the mental health services field and a term symbolic of many of the goals of the consumer / survivor / ex-patient movement. The concept of recovery has often been defined and applied differently by consumers / survivors and professionals. Specific guidelines and clinical strategies were developed to implement the principles of recovery, although important questions remained.

Elements of recovery

It was emphasized that each individual's journey to recovery is a deeply personal process and is related to an individual's community and society. A number of features or signs of recovery have been suggested as frequently core elements and broadly categorized under the concept of CHIME. CHIME is a mnemonic of connectedness, hope and optimism, identity, meaning and purpose and empowerment.

Connectedness and supportive relationships

A common aspect of recovery should be the presence of others who believe in and stand by the person's potential for recovery. According to the relational cultural theory developed by Jean Baker Miller, recovery requires reciprocity and empathy in relationships. The theory is that this requires relationships that embody respect, authenticity, and emotional availability. Supportive relationships can also be made more secure through predictability and avoidance of shame and violence. While mental health professionals can offer a particularly limited type of relationship and help promote hope, it is said that relationships with friends, family, and the community are often of greater and longer-term importance. Case managers can play the role of connecting recoverers to services to which the recovering person may have limited access, such as: B. Grocery stamps and medical supplies. Others who have had similar difficulties and are on the road to recovery can also play a role in community building and in combating the feeling of isolation of a recovering person. In practice, this can be achieved through one-on-one interviews with other people who are recovering, in community stories, or in peer-led self-help groups. Those who share the same values ​​and views in general (and not just in the area of ​​mental health) can also be particularly important. It is said that one-way relationships based on help can actually be derogatory and potentially retraumatizing, and that reciprocal relationships and networks of mutual support can be of greater value to self-esteem and recovery.

To hope

Finding and nurturing hope has been described as the key to recovery. It should not only contain optimism, but also a lasting belief in yourself and the willingness to persevere through uncertainty and setbacks. Hope can begin at a certain turning point or gradually emerge as a small and fragile feeling, wavering with despair. It is said to include trust and disappointment, failure and further hurt.


Restoring a lasting sense of self (when it has been lost or taken away) has been suggested as an important element. Research found that people sometimes achieve this through "positive withdrawal" - regulating social engagement and negotiating public spaces in order to only move to others in a way that feels safe, yet meaningful. and maintaining personal psychological space, which provides space for the development of understanding and a broad sense of self, interests, spirituality, etc. It has been suggested that the process is usually greatly facilitated by experiences of interpersonal acceptance, reciprocity, and a sense of social belonging. and is often challenging in the face of the typical deluge of overt and covert negative messages emanating from the broader social context. Being able to move on can mean coping with feelings of loss, which can include despair and anger. When a person is ready for change, a grieving process is initiated. It may be necessary to accept past sufferings and missed opportunities or lost time.

Develop healthy coping strategies and a meaningful internal scheme

Developing personal coping strategies (including self-management or self-help) should be an important element. This may include the use of medication or psychotherapy if the patient is fully informed and heard, including about side effects and what methods are appropriate for the consumer's life and path of recovery. Developing coping and problem solving skills to cope with individual traits and problem problems (which may or may not be viewed as symptoms of a mental disorder) may require a person to become their own expert to identify key points of stress and potential crisis points and to respond to personal responses - and understand and develop coping methods. Developing a sense of purpose and a general purpose should be important in sustaining the recovery process. This can include restoring or developing a social or professional role. It can also mean renewed, finding or developing a leadership philosophy, religion, politics or culture. From a postmodern perspective, this can be seen as developing a narrative.

Empowerment and building a secure basis

Building a positive healing culture is essential to the recovery approach. Since recovery is a long process, having a strong support network can help. Adequate housing, adequate income, nonviolence, and adequate access to health care have also been suggested as important tools for empowering someone and improving their self-sufficiency. Empowerment and self-determination are said to be important for recovery in order to reduce the social and psychological effects of stress and trauma. The empowerment theory for women suggests that recovery from mental illness, substance abuse, and trauma requires helping survivors understand their rights so that they can improve their ability to make autonomous decisions. This can mean developing confidence in independent, confident decision-making and seeking help, which translates into appropriate medication and active self-care practices. Achieving social inclusion and overcoming challenging social stigmatizations and prejudices about mental distress / disorders / differences is also an important part of empowerment. Proponents of women's empowerment theory argue that it is important to recognize that a recovering person's self-image is maintained by stereotyping and combating those narratives. Empowerment according to this logic requires a reformulation of a survivor's view of himself and the world. In practice, empowerment and building a secure foundation require mutually supportive relationships between survivors and service providers, identifying a survivor's existing strengths, and an awareness of the survivor's trauma and cultural context.

Recovery concepts

Varied definitions

What is meant by "recovery" or a recovery model is a matter of constant debate in both theory and practice. In general, professionalized clinical models tend to focus on improving certain symptoms and functions, as well as the role of treatments, while consumer / survival models tend to place more emphasis on peer support, empowerment, and personal field experience. "Recovery from," the medical approach, is defined by a disappearance of symptoms, while "recovery in," the peer approach, may still involve symptoms but the person feels more in control of their life. Similarly, recovery may be viewed as a social model of disability rather than a medical model of disability, and there may be differences in the acceptance of diagnostic "labels" and treatments.

A review of the research found that authors studying recovery rarely explicitly state which of the various concepts they use. The reviewers classified the approaches they had found into general "rehabilitation" perspectives, which they defined as focused on life and meaning in the context of permanent disability, and "clinical" perspectives, which focus on observable remission of symptoms and the Restoring focused function. From a psychiatric rehabilitation point of view, a number of additional qualities of the recovery process have been suggested, including: they can be done without professional intervention, but require people who believe in and stand by the person in recovery; does not depend on believing certain theories about the cause of conditions; can be said even if symptoms reappear later, but changes the frequency and duration of symptoms; requires recovery from the consequences of a psychiatric illness as well as the illness itself; is not linear, but usually takes place as a series of small steps; does not mean that the person was never truly mentally disabled; focuses on wellness, not disease, and consumer choice.

In a consensus statement on mental health recovery from U.S. authorities that included some consumer input, recovery was defined as a journey of healing and transformation that enables a person with a mental health problem to lead a meaningful life in a community of their choice as they strive to achieve their full potential. Ten basic components were identified, all of which assume that the person is still a "consumer" or has "intellectual disability". Conferences were held on the importance of the "elusive" concept from the perspective of consumers and psychiatrists.

One approach to recovery known as the tidal model focuses on the continuous change process inherent in all humans, the meaning of experiences through water-lifting metaphors. Crisis is seen as an opportunity; Creativity is valued; and different areas such as sense of security, personal narrative and relationships are examined. Originally developed by mental health nurses with service users, Tidal is a special model that has been specifically studied. Based on a discrete set of values ​​(the Ten Commitments), it highlights the importance of each person's voice, ingenuity, and wisdom. Since 1999, projects based on the tidal model have been set up in several countries.

For many, recovery has both political and personal implications - where to recover you have to: Find meaning; Challenging prejudices (including diagnostic "labels" in some cases); perhaps to be a "bad" non-compliant patient and refuse to accept the indoctrination of the system; regaining a chosen life and place in society; and validate the self. Recovery can therefore be viewed as a manifestation of empowerment. Such an empowerment model can emphasize that the conditions are not necessarily permanent. that other people have recovered, can be role models and share experiences; and that "symptoms" can be understood as expressing distress in relation to emotions and other people. One such model by the US National Empowerment Center proposes a set of principles for people recovery and seeks to identify the characteristics of people in recovery.

In general, recovery can be viewed as a philosophy or an attitude rather than a particular model that fundamentally requires "we regain personal power and a cherished place in our communities. Sometimes we need services to help us get there".

Recovery from substance addiction

Certain types of recovery models have been adopted in drug rehabilitation services. While interventions in this area have tended to focus on harm reduction, particularly through replacement prescriptions (or, alternatively, requiring complete abstinence), recovery approaches have emphasized the need to simultaneously address people's entire lives and promote aspirations while providing equal access and equal opportunities to promote society. From a service perspective, work may include helping people “develop the skills to prevent relapse into further illicit drug use, rebuild broken relationships or make new ones, actively engage in meaningful activities and take steps undertake to build a house and take care of themselves and. " Milestones could be as simple as gaining weight, rebuilding relationships with friends, or building self-esteem. It is critical that recovery be sustained. "The key to the philosophy of the recovery movement is the goal of an equal relationship between" experts by profession "and" experts by experience ".

Trauma-informed recovery

Trauma-informed care is a philosophy for recovery that integrates the conditions and needs of people recovering from mental illness and / or substance abuse into one framework. This framework combines all the elements of the recovery approach and adds an awareness of trauma. Proponents of trauma-informed care argue that the principles and strategies should be applied to individuals suffering from mental illness, substance addiction, and trauma, as the three often occur simultaneously or as a result of one another. The paradigms of trauma-informed care began to change in 1998 and 1999. In 1998, the Center for Mental Health Services, the Center for Drug Abuse Treatment, and the Center for Substance Abuse Prevention worked together to fund 14 sites to develop integrated services to address the interrelated effects of violence, mental health and substance abuse. In 1999, the directors of the National Association of Government Mental Health Programs passed a resolution recognizing the effects of violence and trauma and developed a toolkit of resources for implementing trauma services in government mental health agencies. Trauma-informed care has also been supported in science. Scientists claim that neglecting the role of trauma in a person's history can affect recovery in the form of misdiagnosis, inaccurate treatment, or retraumatisation. Some principles of trauma-informed care include the validation of survivors' experience and resilience, which are aimed at improving a survivor's control over their recovery, creating atmospheres for recovery that embody consistency and confidentiality, minimizing the possibility of causing previous trauma , and to integrate survivors. Recovering People in Service Assessment. In practice, trauma-informed care has been found to be most effective when each participant in a service that provides context is committed to following these principles. In addition, these principles can apply to all steps in the recovery process within a service delivery context, including reach and engagement, screening, advocacy, crisis intervention, and resource coordination. The overall goal of trauma-informed care is to promote healing and empowerment through strengths-based empowerment practices and a full suite of services that address concurrent disorders and the multitude of needs a recovering person may have, such as: B. drug treatment, housing, relationship, integrate development and support with parenthood.

These approaches are in contrast to traditional care systems. Proponents of trauma-informed care criticize traditional systems of service delivery such as standard hospitals for failing to understand the role of trauma in a patient's life. Traditional service delivery systems have also been criticized for isolating the conditions of a recovering person and not treating conditions such as substance abuse and mental illness as part of a single source at the same time. Specific practices in traditional service systems, such as unnecessary procedures, undressing for examinations, involuntary hospital stays, overcrowded emergency rooms, and limited time for providers to meet with patients, have been criticized for being insensitive to those recovering from trauma and secondary illness or substance abuse. Limited resources and time in the United States health system can make it difficult to implement trauma-informed care.

In addition to the constraints in the United States health system, there are other challenges to trauma-informed care that can render trauma-informed care ineffective for the treatment of those recovering from mental illness or substance addiction. Proponents of trauma-informed care argue that leading an agency requires a strong commitment to train employees to be trauma-aware. However, this training can be costly and time consuming. "Trauma-informed care" and "trauma" also have controversial definitions and can be difficult to measure in a real-world service environment. Another obstacle to trauma-informed care is the need to be screened for trauma histories. While agencies must look for stories of trauma to ensure the best possible care, there may be feelings of shame and fear of disability that can prevent a recovering person from revealing their personal experiences.

To care

Some concerns have been expressed about a theoretical and practical approach to recovery. This includes suggestions that it: is an old concept; happens to very few people; represents an irresponsible fad; happens only as a result of active treatment; implies a cure; can only be implemented with new resources; increases the burden on already stretched providers; is neither reimbursable nor evidence-based; devalues ​​the role of professional intervention; and increases the risk and liability of providers.

Other criticisms, centered on practical implementation by service providers, include: the recovery model can be manipulated by civil servants to serve various political and financial interests, including withdrawing services and displacing people before they are ready; that it is a new orthodoxy or trait that neglects the empowerment aspects and structural problems of societies and is primarily a middle class experience; that it hides the continued dominance of a medical model; and that it may increase social exclusion and marginalize those who do not fit into a recovery narrative.

Based on the recommendations of the New Freedom Commission on Mental Health, there have been specific tensions between models of recovery and "evidence-based practice" models in the transformation of US mental health services. The Commission's emphasis on recovery has been interpreted by some critics to mean that anyone can fully recover by sheer willpower, thus giving false hope and implicitly blaming those who may not be able to recover. However, the critics themselves have been accused of undermining consumer rights, failing to recognize that the model is intended to assist a person on their personal journey rather than expecting a specific outcome, and that it relates to social and political support and empowerment as well the only one.

Various stages of resistance to recovery have been noted among traditional service workers, beginning with "Our workers are much sicker than yours. They cannot recover" and ending with "Our doctors will never agree". However, ways have been suggested to harness the energy of this perceived resistance and use it to move forward. In addition, training materials have been developed for staff from various organizations, such as the National Empowerment Center.

Some positive and negative aspects of recovery models were highlighted in a study by a community mental health service for people diagnosed with schizophrenia. It was concluded that while the approach can be a useful correction to the usual style of case management - at least if it is genuinely selected and shaped by each individual in the field - serious social, institutional and personal difficulties are sufficient continuation required effective support in coping with stress and coping with everyday life. Cultural prejudices and uncertainties have also been identified in the “North American” model of recreation in practice, which reflects views about the types of contributions and lifestyles that should be considered valuable or acceptable.


A series of standardized questionnaires and ratings have been developed to assess aspects of a person's recovery journey. These include the MOR (Milestones of Recovery) scale, REE (Recovery Enhancing Environment) measurement, RMT (Recovery Measurement Tool), ROSI (Recovery Oriented System Indicators) measurement, STORI (Stages of Recovery Instrument) and numerous related instruments.

The data collection systems and terminology used by services and funders are typically not intended to be compatible with recovery frameworks. Therefore, methods for their adaptation have been developed. It has also been argued that the Diagnostic and Statistical Manual for Mental Disorders (and to some extent any system for categorical classification of mental disorders) uses definitions and terminology that are inconsistent with a recovery model, leading to suggestions for the next version, the DSM, leads -V, requires: greater sensitivity to cultural issues and gender; the need to recognize that others need to change, as well as only those selected to diagnose a disorder; and choose a dimensional assessment approach that better captures individuality and does not falsely imply excessive psychopathology or chronicity.

National policy and implementation

USA and Canada

The New Freedom Mental Health Commission has proposed transforming the US mental health system by shifting the paradigm of care from traditional medical psychiatric treatment to the concept of recovery, and the American Psychiatric Association has a recovery model from a psychiatric perspective Services approved.

The U.S. Department of Health reports on the development of national and state initiatives to empower consumers and support recovery. Specific committees are planning nationwide awareness campaigns to restore and combat stigma. Development and synthesis of recovery guidelines; train consumers to conduct mental health system assessments; and contribute to the further development of peer run services. Mental health service directors and planners provide guidance to help government services implement recovery approaches.

Some US states such as California (see California Mental Health Services Act), Wisconsin, and Ohio are already reporting reshaping their mental health systems to emphasize the values ​​of the recovery model such as hope, healing, empowerment, social connectedness, human rights, and recreational services.

At least some parts of the Canadian Mental Health Association, such as the Ontario region, have adopted recovery as the guiding principle for mental health system reform and development.

New Zealand and Australia

Since 1998, all New Zealand mental health services have been required by government policy to adopt a recovery approach and mental health professionals are expected to demonstrate their competence in the recovery model. The Australian National Mental Health Plan 2003-2008 provides that services should be recreational, although there are differences in knowledge, commitment and implementation between Australian states and territories.

Great Britain and Ireland

In 2005 the National Mental Health Institute in England (NIMHE) endorsed a recovery model as a possible guiding principle for the provision of mental health services and public education. The National Health Service is implementing a recovery approach in at least some regions and has developed a new professional role as Support Time and Recovery Worker. The Mental Health Center issued a policy paper in 2008 suggesting that the recovery approach is an idea "whose time has come" and in partnership with, and with support and funding from, the NHS Confederation Mental Health Network Department of Health managed the implementation of recovery through the Organizational Change (bOC) project across the country aiming to put recovery at the heart of mental health services in the UK. The Scottish Executive has included promoting and assisting recovery as one of its four main mental health goals and has funded a Scottish recovery network to make this possible. A 2006 review of nursing in Scotland recommended a recovery approach as a model for mental health care and intervention. The Mental Health Commission of Ireland reports that their guidance documents put the service user first and highlight a person's personal path to recovery.

See also


further reading

  • Karasaki et al. (2013). The Place of Will in Addiction: Different Approaches and How They Affect Policy and Service Delivery .

External links