Recovery

Clinical recovery

The word ‘recovery’ has two meanings in mental health services.

The first is the traditional meaning – ‘recovering’ from the illness itself and getting back to normal. For many people, including many mental health professionals, recovery means when the symptoms of an illness have gone. This is what mental health professionals call a ‘clinical recovery’.

All studies that have followed the lives of people given a diagnosis of schizophrenia for more than 20 years find that more than half of them experience a clinical recovery in the long term.

In the shorter term, some researchers have estimated that between 14 and 20 per cent of people who experience a first episode of psychosis will have a full clinical recovery. Other people who are given a diagnosis of schizophrenia after a first episode will go on to have one or more further episodes of psychosis, but not necessarily have continuous symptoms. Some people will continue to have symptoms for their rest of their lives.

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Personal recovery

The second meaning of recovery is about recovering a life worth living, without necessarily having a clinical recovery.

This personal recovery occurs when someone builds a life that is satisfying, fulfilling and enjoyable, when they make the most of their lives even if they continue to experience the symptoms of an illness.

This understanding of recovery comes from people who have experience of mental health problems and is based on the idea that each individual should be able to feel in control of – and take decisions about – their own lives, rather than simply doing what a mental health professional tells them.

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Transforming mental health services

Historically, the aim of mental health services has been to achieve clinical recovery through the treatment of symptoms and the prevention of relapse.

Personal recovery, however, demands a different sort of support from mental health services. Mental health professionals still need to prescribe medication and offer therapy – but only if an individual wants this sort of treatment. To support personal recovery, professionals need to work in partnership with people with mental health problems, making joint decisions about what treatment is appropriate, rather than 'knowing what is best.'

In recovery-focused services, the professional acknowledges the expert knowledge each individual has about their own illness and symptoms, and listens to what each person thinks is important to their own recovery. This might be getting a job, living independently, making new friends or learning a new skill, for example. The role of mental health professionals is to help each individual achieve those recovery goals.

Recovery in this sense calls for a major change in the way mental health services are organised. At the moment, for example, mental health professionals sometimes have low expectations of people who have experienced psychosis, even if they have made a clinical recovery.

In some areas, community-based teams of mental health professionals are now called 'recovery and support' teams and work practices are beginning to change.

There are two major research projects that aim to transform NHS mental health services.

The first is called the 'REFOCUS' research programme. This started in 2009 and lasts for five years. It is run by a team of researchers at the Institute of Psychiatry, Psychology & Neuroscience (formerly the Institute of Psychiatry), King's College London, and is funded by the NHS National Institute for Health Research. The programme has several difference strands, but one of them, the REFOCUS trial, is evaluating the success of specially-designed training for front-line staff which aims to make sure their way of working supports the personal recovery of people with mental health problems.

The training encourages mental health professionals to work more collaboratively with people who are unwell, making sure care plans are based on what an individual wants and what is important to them and reflects their preferences for treatment.

The second large project is called the 'Implementing Recovery through Organisational Change' (ImROC) programme and is run by the NHS Confederation's Mental Health Network and the Centre for Mental Health. Nearly 30 NHS organisations are taking part in this programme, which started in 2011. Some have hired paid peer support workers – people with personal experience of mental health problems – to work alongside mental health professionals. Others are developing 'Recovery Colleges.'

A Recovery College is a new type of service that gives people with mental health problems the opportunity to access education and training programmes designed to help them on their road to recovery. The courses are devised and delivered by people with personal experience of mental illness working together with mental health professionals. The idea is that Recovery Colleges help people become experts in self-care and give them the skills and confidence they need for work, and to get on with their lives. At Recovery Colleges, people also make friends and are 'students' rather than 'patients'.

Other research teams and mental health professionals across the country are working with people with experience of mental health problems to test different ways of offering support on recovery journeys. 

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Peer professionals

Peer professionals (also called peer workers and peer support specialists) are people who have personal experience of mental health problems who are employed to work in mental health services. In the USA, mental health services have employed peer professionals for some time. Many mental health trusts in England are now beginning to hire peer professionals to work in mental health services.

A research project led by a team at St George's, University of London and funded by the National Institute for Health Research, investigated the best way of recruiting, training and supporting peer workers in England. This included gathering the experiences and views of people who have already been employed as peer professionals. Find out more by visiting the Peer Worker Research Project website.

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Government support

The government is supporting the concept of recovery – that an individual should be given support to build his or her own life in the way they want to, whether or not the symptoms of the mental illness remain.

The government’s mental health strategy for England was published in February 2011 and is called No health without mental health. One of the strategy’s six main objectives is that ‘more people with mental health problems will recover’. The strategy explains this by saying: ‘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, they skills they need for living and working, improved chances in education, better employment rates and suitable a stable place to live.’

Another two of the six objectives also support recovery – that care and support offered by mental health services should give people the ‘greatest choice and control over their own lives, in the least restrictive environment’ and that ‘fewer people will experience stigma and discrimination.’

The government is also supporting other policies that promote choice in health and social care.

Personalisation describes a way of making sure people who need care and support in the community have the opportunity to plan and choose services that help them live in a way they want to, rather than being told what is best for them by professionals.

For local authorities, a key element of personalisation is the introduction of 'personal budgets' for people who need long-term social care. Instead of organising and commissioning services on behalf of people who need social care, a local authority is instead allocating a sum of money (a personal budget) to eligible individuals who can then use those funds to organise services that meet their particular needs and enhance their life.

The government wants all local authorities to provide personal budgets to everyone eligible for support from social services by April 2013.

Personal budgets are also being introduced into health services 

A personal health budget is an allocation of NHS funding given to a patient (after an assessment). The individual then personally controls that sum of money and uses it to buy services to meet their health needs.  

The government has been piloting personal health budgets. People with mental health problems have been involved in these pilot schemes. The government wants to make personal health budgets more widely available to people who have long-term conditions from April 2014.


 

 


This page was last updated 14 November 2012 (IoP name change incorporated 31 August 2014)
Links last checked: 30 August 2014
Next links check due: December 2014


Resources

Why 'putting the lunatics in charge of the asylum' can work – an article about peer support workers by Professor Mike Slade, a researcher at the Institute of Psychiatry, Psychology & Neuroscience (formerly Institute of Psychiatry) whose research focuses on recovery. The article was published in the online Guardian on Friday 2 March 2012.


Other useful websites

Peer worker research project

– informing new ways of working in mental health. Information about a research project carried out by a team at St George's, University of London.


Resources

Recovery Colleges

a report by Rachel Perkins, Julie Repper, Miles Rinaldi and Helen Brown, produced as part of the Implementing Recovery through Organisational Change research project by the Centre for Mental Health and Mental Health Network NHS Confederation, May 2012.


Freedom to be, the chance to dream: Preserving user-led peer support in mental health

by Alison Faulkner and Jayasree Kalathil, commissioned by the charity Together, 2012.

The report describes the findings from a consultation about the role of peer support, past and present.


Other useful websites

Research into Recovery and Wellbeing

is the website of the recovery research team at the Institute of Psychiatry, Psychology & Neuroscience (formerly Institute of Psychiatry), King's College London.


The Scottish Recovery Network


Resources

Making Recovery a Reality
by Geoff Shepherd, Jed Boardman and Mike Slade
Published by Sainsbury Centre for Mental Health, 2008
Free to download


Personal Recovery and Mental Illness, a guide for mental health professionals
by Mike Slade
published by Cambridge University Press, 2009
A book written primarily for mental health professionals.