A New Model of Recovery from Mental Illness

My understanding of recovery from depression came from experience with the standard treatments: psychotherapy and medication. Until the 1990s, I worked exclusively with psychiatrists for both. In that setting, I can’t recall anyone talking to me about recovery or what I wanted to get out of treatment.

The assumption was that I would be in therapy for the long-term. Whenever I brought up the idea of ending treatment, that became another subject for digging into my past rather than discussing what I wanted for the future. After a while, I became very skeptical of treatment that looked only at illness without a positive model of health. Getting better was all about ending symptoms, and that was it. I had the passive role of a patient under a doctor’s care, not an active role in defining my own recovery.

In the last ten years, that idea of treatment has begun to change, and quite radically. Of course, it’s taken a political movement, aimed mostly at federal mental health agencies, to get things going – just as it did to get official recognition for Post Traumatic Stress Disorder. But it’s not limited to action in Washington, DC. Questions have also been raised within the mental health professions, and the major associations are all supporting the recovery initiative, including the American Psychiatric Association. Even though it’s still early days – mostly about formal definitions, policies and training – what they’ve come up is remarkable – at least on paper.

Look, for example, at the National Consensus Statement on Mental Health Recovery. The concept of recovery has been so little used in mental health circles that it took a conference organized by eight federal agencies with 110 participating experts just to define what it meant.

Here’s the definition.

Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.

I had to stare at that phrase, “journey of healing and transformation,” for a while before it sank in. As a veteran of conferences and consensus building around government policy, I can imagine the intense discussion and negotiation that went into each phrase in the definition. I was all the more amazed at “journey of healing and transformation.” In a setting like that, such words are usually greeted with groans of derision.

Along with the definition, the conference group identified 10 guiding principles of recovery that sharply contrast with past approaches to mental health practice. While quoting directly, I’ve edited each one down to its core idea.

  1. Self-Direction: … By definition, the recovery process must be self-directed by the individual, who defines his or her own life goals and designs a unique path towards those goals.

  2. Individualized and Person-Centered: There are multiple pathways to recovery based on an individual’s unique strengths and resiliencies … . Individuals also identify recovery as being an ongoing journey and an end result as well as an overall paradigm for achieving wellness and optimal mental health.

  3. Empowerment: Consumers have the authority to choose from a range of options and to participate in all decisions… . … Through empowerment, an individual gains control of his or her own destiny and influences the organizational and societal structures in his or her life.

  4. Holistic: Recovery encompasses an individual’s whole life, including mind, body, spirit, and community. …

  5. Non-Linear: Recovery is not a step-by-step process but one based on continual growth, occasional setbacks, and learning from experience. … Recovery begins with an initial stage of awareness in which a person recognizes that positive change is possible. This awareness enables the consumer to move on to fully engage in the work of recovery.

  6. Strengths-Based: Recovery focuses on valuing and building on the multiple capacities, resiliencies, talents, coping abilities, and inherent worth of individuals. … The process of recovery moves forward through interaction with others in supportive, trust-based relationships.

  7. Peer Support: Mutual support—including the sharing of experiential knowledge and skills and social learning—plays an invaluable role in recovery. Consumers encourage and engage other consumers in recovery and provide each other with a sense of belonging, supportive relationships, valued roles, and community.

  8. Respect: Community, systems, and societal acceptance and appreciation of consumers —including protecting their rights and eliminating discrimination and stigma—are crucial in achieving recovery. Self-acceptance and regaining belief in one’s self are particularly vital. …

  9. Responsibility: Consumers have a personal responsibility for their own self-care and journeys of recovery. Taking steps towards their goals may require great courage. Consumers must strive to understand and give meaning to their experiences and identify coping strategies and healing processes to promote their own wellness.

  10. Hope. Recovery provides the essential and motivating message of a better future— that people can and do overcome the barriers and obstacles that confront them. … Hope is the catalyst of the recovery process. …

The professional associations of psychiatrists, psychologists, psychiatric nurses, social workers and others are developing training programs for their members on applying these principles to everyday practice. It’s not going to be easy to change deeply established practices, attitudes and professional cultures. I’ve seen many initiatives of this type in other fields slowly die out while trying to bring about such changes.

Whatever happens over the next few years, there is now an alternative model of recovery from mental illness to work with. It’s especially important for people like me who have tried to find their on way to wellness. Hopefully, the providers will adopt its values as well.

Image Credit: Some rights reserved by falcon0125 at Flickr.

6 Responses to “A New Model of Recovery from Mental Illness”

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  1. Maronne says:

    Very cool. I am psyched that the “10 guiding principles of recovery” are the principals that I’ve always needed and insisted upon when seeking professional help. (Although, at my worst I really never knew WHAT I was seeking — just HELP – whether it just end up being the company of a kind-hearted other.)

    I have one question about their definition of mental health recovery:
    “Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential”

    My question is how do they define a “MEANINGFUL LIFE”? Any thoughts?

    • John says:

      Hi, Maronne –

      That’s a good question, right along with trying to define recovery. The lead government agency on this has in fact come out with a wellness campaign that lists 8 dimensions of wellness (social, emotional, occupational etc). They’ll talk about the qualities that characterize the ML, not try to define it in so many words. If you’re familiar with govt agencies, part of what they’re doing – besides public education – is setting up criteria for deciding who gets grant funds – but I’m not going there on this blog.

      I’m looking into this and other aspects of the recovery “movement” and will write more about it soon.

  2. This is my first time on your blog. It provides a great new model of recovery. Keep writing!

  3. Karen says:

    Thanks for reporting on this development. As you say, it could be just another one of those documents, but it may spur new thinking.

    In my experience, the psychoanalysis approach doesn’t help you much with resolving problems. My therapy has been with MSWs who focus more on “problems with daily living” or goals and recovery. I liked my therapist who just talked about what was going on that I was dealing with, but also talked about the childhood and family that set up conflicts and damage that resonated with current issues and made them more powerful than they otherwise would have been. I needed her for many years, but when I reached a point when I thought I could manage on my own, she never tried to talk me out of it, just let me know I could come back if I needed to, which I did a couple of times when things got tough. I really couldn’t talk about the issues in my life with anyone else. She retired but I felt I was OK and didn’t need a referral to someone else.

    A couple of years ago I tried therapy with a woman who was all about goals and changing what I did – in particular, getting out and meeting people more. There was homework. She also had me talk about my whole history. Re-experiencing trauma at different ages and stages does give you new perspectives. While the approach may be OK, she might not have been the right person.

    Therapy always seems to cause conflict in my marriage. I haven’t gone to a therapist since.

    My psychiatrist sticks to meds and symptoms only, but is a very caring and sympathetic person. She’ll go along with standing pat when I want to stop experimenting, but sometimes has strongly encouraged me to try something new. Many times the experiments fail because of side effects, as anyone who’s been on the medication track knows. She says she’d like me to be at “100%” but I have a strong feeling that at my age, with long term illness dating back to childhood, I’ll be lucky to be at 80%. I still hope for scientists to crack the code for my particular illness.

    She also said, after my last attempt at therapy just made me feel worse, that she didn’t think going back over the past was always such a good idea. Since then I’ve tried to take a more, been-there-done-that approach to my thinking and stay more in the present, including putting some social and professional challenges in my path.

    So it comes back to the “problems with daily living” issue. We need different kinds of support at different times and we need the knowledge and respect that puts us in charge. Being the driver of our own bus takes away some of the helplessness that leads to more intense depression.

  4. Evan says:

    A wonderful initiative.


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