What is recovery?

Dr Mike Slade: So what does ‘recovery’ mean? Well what we now know is that there are two, though in some ways overlapping, different meanings. One meaning that we can call ‘clinical recovery’ is the traditional understanding in the mental health system that recovery is about treatment and cure of mental illness – it’s about not having symptoms any more, it’s about staying out of hospital, it’s about being able to function in the community in the same way everyone else would and essentially being better – being back to normal. 

The second meaning of recovery, which we can call ‘personal recovery’, is in some ways quite a different understanding, it’s much more focused on the experience of living, the experience we all have of trying to find a life worth living. The idea of personal recovery is that recovery may be open to people who are experiencing symptoms of mental illness – that it is possible to have a meaningful and purposeful life worth living whether or not you happen to have experiences of depression or psychosis or other types of mental illness.

So clinical recovery, if it becomes the sole pre-occupation, for some people it’s very helpful but for some people it gets in the way of their recovery, and the system can do better. 

For some people, they have an experience of mental illness and they come into the mental health system, they receive effective, evidence-based interventions, their life gets back to normal and they go on with their life. So clinical recovery is exactly what they’ve achieved and what they need – so for one group of people it’s a very helpful focus in the mental health system.

For other people it’s rather neutral. They get offered interventions and treatments that never quite live up to their promise, but they find a way forward in their life, for example: through other approaches such as spirituality, or social support, or finding a job or a partner, or some other life event that allows them to get back into their life – and the mental health system has a relatively modest impact on that recovery process.

But, there is a third group, for whom the current preoccupations of the mental health system, with its focus on the importance of treatment as a central, driving goal of the system, are actually toxic. They hold people back from having a life worth living because the assumption embedded in the system is that you need treatment before you can get on with your life. What we are now learning from the experience of many people with personal experience of mental illness, is it can be more helpful to start with a focus on getting people back into their life, and within that treatment for mental illness may provide a very valuable contribution. But it’s not the main event – and so given that some people find recovery outside of the system, we need to support that process.