Recovery

• Clinical recovery
• Personal recovery
• Transforming mental health services
• Peer professionals
• Government support

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, mental health services have aspired 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.

In recovery-focused services, the professional no longer ‘knows best’. Instead, they acknowledge the expert knowledge each individual has about their own illness and symptoms, and listen to what each person thinks is important. The role of mental health professionals is to help each individual 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 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.

A team of researchers at the Institute of Psychiatry is running a large five-year research programme, investigating how mental health services in England can best promote the personal recovery of people with experience of mental health problems. The REFOCUS programme started in 2009, is funded by the NHS National Institute for Health Research and has several strands. One of them, the REFOCUS trial, is evaluating whether specially designed training can help members of community mental health teams better support people's individual recovery. The training, detailed in the REFOCUS manual, encourages mental health professionals to work more collaboratively with people who are unwell, making sure care plans are based on what an individual wants, what is important to them and their treatment preferences.

Other research teams and mental health professionals across the country are working with people with experience of mental health problems to find out the best way of offering support on recovery journeys. Ideas that are being trialled include:

• a recovery guide, developed in collaboration with people who have experience of mental health problems;

• Recovery Education Centres set up in NHS mental health trusts to train and support people with experience of mental health problems to work within mental health services and/or offer support to people embarking on a recovery journey, the mental health professionals who work with them and their families;

• partnership work between mental health trusts and other organisations that provide housing and employment, for example, so these sort of services become central to the support offered to individuals, rather than add-on ‘extras’;

• recruiting people with experience of mental health problems to work in mental health services as paid peer professionals.

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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, aims to find out the best way of recruiting, training and supporting peer workers in England. This will include gathering the experiences and views of people who have already been employed as peer professionals.

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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 new 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.

At the moment, the focus is on personalisation within social care services, but the concept is 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 and people with mental health problems who are eligible for NHS continuing care have been involved in these pilot schemes. A final evaluation of the pilot programme is due to report in October 2012 and the government will make recommendations for the future of personal health budgets after that time.