What about medication and compulsory treatment? How do they fit in with the concept of personal recovery?

Dr Mike Slade: Traditional mental health services have often implicitly constructed their job as all about getting people to take treatment and, in particular, medication. In a recovery-oriented mental health system there’s a different imperative – the imperative is to support the person to get on with their life, to find a life worth living. 

So the mental health system re-orientation involves recognising that deciding to stop taking medication for some people may be very healthy behaviour. Not for all people, but for some people.

So in practice what does that mean?  It means that mental health system professionals like me don’t start with an assumption that medication is good.  We start with an assumption that medication, like any clinical intervention, is a personal decision that the individual needs to make. 

And we support, with unbiased information, the person to make that decision because we have a view that the individual taking responsibility for their own life is more important than everyone taking medication that we think would benefit from it. 

So how does personal recovery fit with compulsory treatment and assertive outreach teams that try and engage with disengaged people? it’s a debated and contested question. 

Now my own view, is that there is a time, in a civilized society, when we need to realise that an individual may have lost the ability to take care of themselves and look after themselves. 

And I think that in a decent, civilized society, society should sometimes have the mandate to step in and use compulsion if necessary to stabilize the situation. 

I think the challenge though is that although we have excellent skills in that domain, we are not yet as good as we should be about not just creating a safety net but making that safety net springy. In other words, as soon as possible supporting the person out of the crisis and back into their life. And sometimes the way we work doesn’t fully help the person to get back into their life as soon as possible.