Recovery

• What is recovery?
• Transforming mental health services
• Progress so far
• REFOCUS research project

What is recovery?

There are two meanings to the word ‘recovery’.

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’.

Some researchers have estimated, for example, that between 14 and 20 per cent of people who experience a first episode of psychosis will have a full clinical recovery. However, some studies have followed the lives of people given a diagnosis of schizophrenia for more than 20 years and shown that more than half them experience a clinical recovery in the long term. Others 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 the rest of their lives.

The second meaning of recovery is about recovering a life worth living, without necessarily having a clinical recovery. This occurs when someone builds a life that is satisfying, fulfilling and enjoyable, whether or not he or she continues to experience the symptoms of an illness. It is a ‘personal recovery’, which may mean living with some symptoms, but is more about the things people can do and achieve rather than the limitations caused by an illness. This understanding of recovery comes from people who have mental health problems themselves and is based on the idea that each individual should be able to feel in control of their own lives, rather than simply doing what the ‘expert’ tells them.

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Transforming mental health services

At the moment, health services mostly aspire to achieving 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 want 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.

In recovery-focused services, the professional no longer ‘knows best’. Instead, they acknowledge the expert knowledge each individual has about their own illness and listen to what each person wants to achieve. The role of mental health professionals is to help each individual to realise their own goals and ambitions – which may include securing a job, living independently, making new friends or learning a new skill, for example.

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, even if they have made a clinical recovery. Mental health professionals will need to have a hopeful expectation about the possibility of a good for each individual. This is an important attitude because hopefulness, like hopelessness, is contagious. Services will need to be geared more towards supporting the desires, expectations and overall wellbeing of each individual.

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Progress so far

The concept of recovery – that an individual should be given support to build their own life in the way they want to, whether or not the symptoms of the mental illness remain – is supported by the Department of Health through policies promoting choice in healthcare and self-management of long-term conditions.

‘Personalisation’ describes a government plan to reform public services and give people the chance to live their own lives in the way they want to. Direct Payments and Individual Budgets are part of personalisation policies and there are links to find out more about them on this page. Direct Payments and Individual Budgets can make it easier for people to make their own decisions about the sort of support they receive, rather than be dependent recipients of care.

‘Personalised care planning’ also comes under the umbrella of ‘Personalisation’ and aims to give people with long-term conditions more control over treatments and services, and put people on more of an equal footing with health and social care professionals.

The principle of personal recovery has also been backed by governments in Scotland, Ireland Canada, New Zealand, the United States and Australia.

Health organisations in England are now beginning to talk seriously about how best to change the way their services run to incorporate the new meaning of recovery and offer people with mental health problems support in a different, more equal way.

The Sainsbury Centre for Mental Health is a campaigning organisation that has published papers on ‘Implementing Recovery’ in a bid to get health professionals and the services within which they work begin to change.

Some of the things that are being proposed to help services become more geared towards recovery are:

• Training programmes for all staff led by the people who use services.

• Recovery Education Centres in NHS mental health trusts to train and support people with experience of mental health problems to work with staff and other service users as ‘peer professionals’ in mental health services.

• Partnership work with other organisations that provide housing and employment, for example, so these sort of services become central to the support offered to individuals, rather than ‘extras’.

• Recruiting more people with experience of mental health problems to mental health services as paid staff, including as managers.

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REFOCUS research project

Mike Slade, a researcher at the Institute of Psychiatry, is running a large five-year research programme about recovery and how mental health services in England might change. The programme started in 2009 and is funded by the NHS National Institute for Health Research.

The project is called REFOCUS and has several strands, including a national survey of existing services and a survey of people who use mental health services to find out if any elements of the recovery concept are already being put into practice.

The research team is developing ways of helping mental health professionals extend their knowledge and skills to better support the personal recovery of individuals – through training, for example. This will then be evaluated in a trial based in south London and Gloucester to see if changing attitudes and working practice makes a difference.