Approaches to Recovery
Approaches to Recovery
Over the last two decades, significant strides have been made in promoting the recovery of persons with serious mental illnesses. These strides have been made in two complementary, yet distinct, ways. First, in the sense of “clinical recovery,” there are a range of effective medications, psychotherapies, and approaches to cognitive remediation that can reduce the symptoms and cognitive disruptions that are associated with serious mental illnesses. There are, that is, effective treatments and rehabilitation strategies that can lessen the suffering and struggles caused by these conditions and that can help to restore the person’s functioning. In fact, over half of persons with a first episode of psychosis will experience full remission from symptoms and return to prior functional roles. In addition to good prognostic factors (e.g., premorbid functioning, timely access to care), the persons themselves and supportive families can play active and integral roles in promoting this form of recovery.
These is also a second sense of recovery, though, which makes a full, self-directed, and meaningful life available even to those persons who may not experience full symptom remission. This form of recovery has come to be called “personal recovery” and it can be promoted through a range of additional interventions and strategies that focus on enabling the person to function despite, or within the limitations imposed by, a persistent mental health condition. These services and recovery supports are most readily understood as being of use to persons who have “psychiatric disabilities,” in that they offer accommodations that enable people to overcome or compensate for remaining difficulties or disabilities. Examples of such approaches are supported housing, supported education, supported employment, supported socialization, supported parenting, and supported spirituality. All of these represent the provision of supports in vivo, in the real-world contexts in which people choose to live, learn, work, socialize, be part of a family, and exercise their faith—all of which are valued pursuits and interests of all of us, whether or not one has a mental illness.
Recovery-oriented practices are those practices that promote either clinical recovery, personal recovery, or both. They do this by identifying and building on personal and family strengths and by being aligned with the person’s own values, preferences, and goals. These values, preferences, and goals are elicited through the process of person or family-centered care or recovery planning, in which practitioners work collaboratively to develop action plans for what the different parties involved agree to do to in support of the person’s recovery. After identifying their major life goals, the person is assisted in identifying those step they need to make in exercising effective self-care and in pursing their interests and aspirations. Involved families are assisted in identifying ways in which they can support the person’s own efforts and ways in which they can contribute more directly to the recovery process, from driving their loved one to school or work or reminding them to take care of themselves (e.g., get enough sleep, take medications as prescribed), to celebrating successes and conveying understanding and acceptance while commiserating over setbacks.
The person or family-centered care/recovery plan also stipulates what services and supports the person will be able to utilize, from professionally delivered treatments (e.g., medications, psychotherapies) to supports that can be provided by peer and rehabilitative staff or other natural supporters (e.g., friends, landlords, tutors, employers). Decisions about what services and supports, at what frequency, provided by whom, and for what purposes are ideally made through a shared decision-making process in which there is a two-way (or three-way, if including family) exchange of information and concerns that focus on maximizing the person’s opportunities and abilities to live as full and self-directed a life as possible.
Since such care/recovery plans often involve different mental health and other providers in different roles (e.g., psychiatrist prescribing medication, nurse supporting self-care, nurse practitioner monitoring blood pressure, job coach helping the person to obtain and sustain meaningful employment), recovery-oriented practices are best supported within the context of a recovery-oriented system of care which ensures continuity of care both across providers/agencies and over time. In addition to coordinating, if not integrating, all of the care and supports the person, and possibly family, receive, recovery-oriented systems of care proactively build bridges between mental health services and supports and the local communities in which they are provided, creating and sustaining pathways to community inclusion that enable persons with serious mental illnesses to exercise their full citizenship both at home and in all of those places where they live, learn, work, play, love, and belong.