recovery in mental health
TRANSCRIPT
Recovery in Mental HealthAGNES BEZZINA
TEACHING FELLOW – SOCIAL WORKUNIVERSITY OF BRISTOL
08.02.2016
Session Plan INTRO: What does recovery look like to you? What recovery looks like to me … A history of recovery in mental health The Social Construction of Recovery Definitions … The Clinical vs The Personal Frameworks and Stars – Quantifying Recovery? Abuses of Recovery Ten Top Tips to Recovery-Oriented Practice Recovery and Social Work Towards a Social Justice Definition of Recovery
What does recovery look like to you?
What recovery looks like to me at present …
An integrated identity …
A history of recovery …The story of John Thomas Perceval (1803 – 1876) …
Detained in ‘mental asylums’ for a number of years, including Brislington House in Bristol
A history of recovery …
Perceval speaks of his ‘recovery’, attributing this to various factors, including:• access to books
he enjoyed reading;
• contact with family;
• spirituality;• acceptance by
others; and• being a voice
for others.
A history of recovery …
(Bateson, 1961, p.xiii)
Perceval turned his rage into action, and the same action proved fundamental to his recovery. He has been acknowledged as a mental health advocacy pioneer for his lifetime campaign. (Brandon, 2007)
A history of recovery … The initial impetus for the development of ‘recovery’
in mental health came from the ‘survivor’ movement, most particularly within the United States during the late 1980s and early 1990s (Roberts & Wolfson, 2004).
Publishing of a number of first-person accounts of ‘recovery’ from mental illness: Marcia Lovejoy (1984): Recovery From Schizophrenia: A
Personal Odyssey Esso Leete (1989): How I Perceive and Manage my
Illness Ron Coleman (1999): Recovery: An Alien Concept
‘Recovery’ integrated into policy
The journey to recovery: the Government’s vision for mental health care (2001): “The mental health system must support people in settings of
their own choosing, enable access to community resources including housing, education, work, friendships – or whatever they think is critical to their own recovery” (p.24)
No health without mental health (2011): “Objective (ii) – More people with mental health
problems will recover: More people who develop mental health problems will have a good quality of life – greater ability to manage their own lives, stronger social relationships, a greater sense of purpose, the skills they need for living and working, improved chances in education, better employment rates, and a suitable and stable place to live.” (p.30)
The Social Construction of Recovery
Countless definitions of ‘recovery’:“Each definition uses its own language and fits different disciplines, models or frameworks…there are unlimited definitions and meanings of recovery, none of which are right or wrong…” (Campbell et.al, 2013, p.39)
YET, from a Foucauldian perspective, power relations in society are expressed through language use – or discourse
Therefore, the definition we adopt represents a particular discourse, a particular way of thought, and we need to reflect on the role of power within this discourse.
Some definitions …
CLINICAL Recovery …
Full symptom remission, full or part time work / education, independent living without supervision by informal carers, having friends with whom activities can be shared – sustained or a period of 2 years(Lieberman and Kopelowicz, 2002)
Some definitions …
“The goal of recovery is not to become normal. The goal is to embrace the human vocation of becoming more deeply, more fully human.” (Pat Deegan, 1996)
“Recovery is not a gift from clinicians, but the responsibility of us all. We must become confident in our own ability to change our lives, we must give up being reliant on others doing everything for us. We must have the confidence to give up being ill so that we can start being recovered.” (Ron Coleman, 1999)
PERSONAL Recovery …
http://www.mentalhealthcare.org.uk/view_all_videos/mike_slade_video_clip_1
The Clinical vs The Personal …
EXTRACT FROM CLINICAL NOTES
• “Flat. Lacking in motivation, sleep and appetite good. Discussed aetiology. Cont. LiCarb 250mg qid. Levels next time.”
EXTRACT FROM DIARY
• “Today I wanted to die. Everything was hurting. My body was screaming. I saw the doctor. I said nothing. Now I feel terrible. Nothing seems good and nothing good seems possible. I am stuck in this twilight mood where I go down into a lonely black hole. Where there is room for only one.”(O’Hagan, 1996)
The CHIME Framework
Connectedness
Hope and optimism
Identity
Meaning and purpose
Empowerment
(Leamy, Bird, Le Boutillier, Williams and Slade, 2011)
The Recovery Outcomes Star …
Quantifying recovery?? ‘Processes’ vs ‘outcomes’
Is the primary loyalty to: “the application of a rather reductionist form of science” OR “the honouring of lived experience and to justice in service
systems and the wider society” (O’Hagan, 2012a)
“…lack of standardisation in data collection” (Dickens et.al, 2012)
Conceptualising recovery as a ‘model’ “…may fit with the constructs and understanding of
practitioners” BUT “could destroy the essence of recovery from the service-user
discourse drawn from lived experience” (Campbell et.al 2012, p.39)
There is a sense of ‘recovery’ being hijacked by professionals (O’Hagan, 2012b)
ABUSES of Recovery …
1. Recovery is the latest model;2. Recovery does not apply to “my” patients;3. Services can make people recover through
effective treatment;4. Compulsory detention and treatment aid
recovery;5. A recovery orientation means closing services;6. Recovery is about making people independent
and normal;7. Contributing to society happens only after the
person has recovered.(Slade et.al, 2014)
Recovery and Social Work …
The central tenets of the recovery movement are supported by social work values, most notably those of:
consumer empowerment self-determination worth of the individual, and concern for the environmental role in personal experience
(Carpenter, 2002) For social work, ‘recovery’ should not be just about facilitating
personal change, but also about generating change in the oppressive structures that are hindering recovery:
“…finding ways in which service users, family, friends and practitioners can work collaboratively both to challenge and to resist the corrosive impact of social oppression.”
(Tew et.al 2012, p.455)
Towards a social justice definition of recovery … “…facilitating social justice for persons in
recovery means directly targeting the injustices and discrimination that they experiences due to stigma” (Carr et.al 2014, p.1112)
“
“…recovery-oriented social work interventions should be directed at promoting social citizenship for people diagnosed with mental illness, combating stigma, and creating the psychological and social environments for finding meaning and hope after receiving a diagnosis.” (Williams, Almeida, & Knyahnytska, 2015)
Recovery is …‘Recovery’ is the term that mental health service user activists adopted as a political statement to spotlight the totality of their being, away from professionals’ definition of maintaining a symptom-free existence, to one in which they live life in its entirety, in the way they choose, while establishing their own strategies to manage their mental health.
It is also the word that some mental health service user activists are now considering abandoning as they believe that this has been ‘colonised’ by professionals, and integrated into policy in a way that makes it unrecognisable to them, as it has been reduced to measureable outcomes debasing their personal, individual journey as a process.
References Bateson, G. (1961). Perceval’s Narrative: A Patient’s Account of
his Psychosis 1830-1832. Stanford: Stanford University Press. Brandon, D. (2007, October). A friend to alleged lunatics. Mental
Health Today: 37-39. Campbell, J., Stickley, T. Bonney, S. and Wright, N. (2012).
Recovery as a framework for care planning. In A. Hall, M. Wren and S.D. Kirby (Eds.) Care Planning in Mental Health: Promoting Recovery. Oxford: Wiley Blackwell.
Carpenter, J. (2002). Mental health recovery paradigm: implications for social work. Health and Social Work, 27(2): 86-94.
Carr, E.R., Bhagwat, R., Miller, R. and Ponce, A.N. (2014). Training in mental health recovery and social justice in the public sector. The Counselling Psychologist, 42(8): 1108-1135.
Coleman, R. (1999). Recovery: An Alien Concept. Gloucester: Handsell Publishing.
Deegan, P. (1996). Recovery as a journey of the heart. Psychiatric Rehabilitation Journal, 19(3): 91-97.
Department of Health (2001). The Journey to Recovery: The Government’s Vision for Mental Health Care. London: DOH.
Dickens, G., Weleminsky, J., Onifade, Y. and Sugarman, P. (2012). Recovery Star: validating user recovery. The Psychiatrist Online, 36: 45-50.
HM G. (2011). No Health Without Mental Health: Developing Better Mental Health Outcomes for People of all Ages. London: Department of Health
Leamy, M., Bird, V., Le Boutillier, C., Williams, J. and Slade M. (2011) Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis. The British Journal of Psychiatry, 199(6): 445-452.
Leete, E. (1989). How I perceive and manage my illness. Schizophrenia Bulletin, 15(2): 197-200.
Lovejoy, M. (1984). Recovery from schizophrenia: a personal odyssey. Psychiatric Services, 35(8): 809-812.
O’Hagan, M. (1996). Two accounts of mental distress. In J. Read and J. Reynolds (Eds), Speaking Our Mind. London: Macmillan.
O’Hagan, M. (2012a). Recovery: is consensus possible? World Psychiatry, 11(3): 167-168.
O’Hagan, M. (2012b). The science of recovery. Retrieved from: http://www.scottishrecovery.net/Latest-News/the-science-of-recovery.html
Roberts, G. and Wolfson, P. (2004). The rediscovery of recovery: open to all. Advances in Psychiatric Treatment, 10(1): 37–49.
Slade, M., Amering, M., Farkas, M., Hamilton, B., O’Hagan, M., Panther, G., Perkins, R., Shepherd, G., Tse, S., and Whitley, R. (2014). Uses and abuses of recovery: implementing recovery-oriented practices in mental health systems. World Psychiatry, 13(1): 12-20.
Tew, J., Ramon, S., Slade, M., Bird, V., Melton, J. and Le Boutillier, C. (2012). Social factors and recovery from mental health difficulties: a review of the evidence. British Journal of Social Work, 42(3): 443-460.
Williams, C.C., Almeida, M. and Knyahnytska, Y. (2015). Towards a Biopsychosociopolitical frame for recovery in the context of mental illness. British Journal of Social Work, 45, Supplement 1, i9–i26.