Recovery model: Difference between revisions

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<ref>{{cite journal | last1 = van Bilsen | first1 = Henck P. J. G. | year = 2016 | title = Lessons to be learned from the oldest community psychiatric service in the world: Geel in Belgium | url = https://www.cambridge.org/core/services/aop-cambridge-core/content/view/696139AC7D0510562534886F4A4763B2/S2056469400002126a.pdf | journal = BJPsych Bulletin | volume = 40 | issue = 4 | pages = 207–211 | doi = 10.1192/pb.bp.115.051631 | pmid = 27512591 | pmc = 4967781 | access-date=March 19, 2023 }}</ref><ref>[https://www.belganewsagency.eu/the-remarkable-story-of-geel-700-years-of-community-based-mental-health-care The remarkable story of Geel: 700 years of community-based mental health care]</ref><ref>{{citation | last1 = Stevis-Gridneff | first1 = Matina | last2 = Ryckewaert | first2 = Koba | url = https://www.nytimes.com/2023/04/21/world/europe/belgium-geel-psychiatric-care.html | archive-url = https://archive.today/20230425140349/https://www.nytimes.com/2023/04/21/world/europe/belgium-geel-psychiatric-care.html | archive-date = 2023-04-25 |title = Radical Experiment in Mental Health Care, Tested Over Centuries | work = New York Times | year=2023}}</ref>

More widespread application of recovery models to psychiatric disorders is comparatively recent. The concept of recovery can be traced back as far as 1840, when [[John Thomas Perceval]], son of Prime Minister [[Spencer Perceval]], wrote of his personal recovery from the psychosis that he experienced from 1830 until 1832, a recovery that he obtained despite the "treatment" he received from the "lunatic" doctors who attended him.<ref>[https://web.archive.org/web/20190919204034/http://www.recoverywithinreach.org:80/Recovery/history History of the Recovery Movement]</ref> But by consensus the main impetus for the development came from within the [[Psychiatric survivors movement|consumer/survivor/ex-patient movement]], a grassroots self-help and advocacy initiative, particularly within the [[United States]] during the late 1980s and early 1990s.<ref name="USsurgeon">Office of the Surgeon General and various United States Government agencies (1999) [https://web.archive.org/web/20200930094830/https://profiles.nlm.nih.gov/spotlight/nn/catalog/nlm:nlmuid-101584932X120-doc Mental Health: A report of the Surgeon General. Section 10: Overview of Recovery]</ref> The professional literature, starting with the [[psychiatric rehabilitation]] movement in particular, began to incorporate the concept from the early 1990s in the United States, followed by New Zealand and more recently across nearly all countries within the "[[First World]]".<ref name="RecoveryEmergent">{{cite journal |vauthors=Ramon S, Healy B, Renouf N |title=Recovery from mental illness as an emergent concept and practice in Australia and the UK |journal=Int J Soc Psychiatry |volume=53 |issue=2 |pages=108–22 |date=March 2007 |pmid=17472085 |doi=10.1177/0020764006075018|s2cid=25732602 }}</ref> Similar approaches developed around the same time, without necessarily using the term recovery, in Italy, the Netherlands and the UK.

Developments were fueled by a number of long-term outcome studies of people with "major mental illnesses" in populations from virtually every continent, including landmark cross-national studies by the [[World Health Organization]] from the 1970s and 1990s, showing unexpectedly high rates of complete or partial recovery, with exact statistics varying by region and the criteria used. The cumulative impact of personal stories or [[testimony]] of recovery has also been a powerful force behind the development of recovery approaches and policies. A key issue became how service consumers could maintain the ownership and authenticity of recovery concepts while also supporting them in professional policy and practice.<ref name="Deegan88">{{cite journal | author = Deegan PE | year = 1988 | title = Recovery: The lived experience of rehabilitation | url = http://www.bu.edu/cpr/repository/articles/pdf/deegan1998.pdf | journal = Psychosocial Rehabilitation Journal | volume = 11 | issue = 4| page = 4 | url-status = dead | archive-url = https://web.archive.org/web/20070926115018/http://www.bu.edu/cpr/repository/articles/pdf/deegan1998.pdf | archive-date = 2007-09-26 | doi = 10.1037/h0099565 }}</ref>

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===Connectedness and supportive relationships===

A common aspect of recovery is said to be the presence of others who believe in the person's potential to recover<ref name=":0">{{Cite journal|last1=Francis East|first1=Jean|last2=Roll|first2=Susan J.|date=2015|title=Women, Poverty, and Trauma: An Empowerment Practice Approach: Figure 1|journal=Social Work|language=en|volume=60|issue=4|pages=279–286|doi=10.1093/sw/swv030|pmid=26489348|issn=0037-8046}}</ref><ref name=":1">{{Cite journal|last1=Hopper|first1=Elizabeth K.|last2=Bassuk|first2=Ellen L.|last3=Olivet|first3=Jeffrey|date=2010-04-07|title=Shelter from the Storm: Trauma-Informed Care in Homelessness Services Settings~!2009-08-20~!2009-09-28~!2010-03-22~!|journal=The Open Health Services and Policy Journal|volume=3|issue=2|pages=80–100|doi= 10.2174/1874924001003020080 |doi-broken-date=221 MarchJuly 2025 |doi-access=free|s2cid=10319681|issn=1874-9240}}</ref> and who stand by them. According to Relational Cultural Theory as developed by Jean Baker Miller, recovery requires mutuality and empathy in relationships.<ref name=":0" /> The theory states this requires relationships that embody respect, authenticity, and emotional availability.<ref name=":0" /><ref name=":2">{{Cite journal|last=Reeves|first=Elizabeth|date=2015-09-02|title=A Synthesis of the Literature on Trauma-Informed Care|journal=Issues in Mental Health Nursing|volume=36|issue=9|pages=698–709|doi=10.3109/01612840.2015.1025319|issn=0161-2840|pmid=26440873|s2cid=36312879}}</ref> Supportive relationships can also be made safer through predictability and avoiding shaming and violence.<ref name=":2" /><ref name=":0" /><ref name=":3">{{Cite journal|last1=Elliott|first1=Denise E.|last2=Bjelajac|first2=Paula|last3=Fallot|first3=Roger D.|last4=Markoff|first4=Laurie S.|last5=Reed|first5=Beth Glover|date=2005|title=Trauma-informed or trauma-denied: Principles and implementation of trauma-informed services for women|journal=Journal of Community Psychology|language=en|volume=33|issue=4|pages=461–477|doi=10.1002/jcop.20063|s2cid=145560079 |issn=0090-4392}}</ref> While [[mental health professional]]s can offer a particular limited kind of relationship and help foster hope, relationships with [[friendship|friends]], [[family]] and the [[community]] are said to often be of wider and longer-term importance.<ref name="Friendships">Hack Thyself (2012) [http://hackthyself.net Recovery Is Impossible Without Friends] {{Webarchive|url=https://web.archive.org/web/20161004024621/http://hackthyself.net/ |date=2016-10-04 }}</ref> Case managers can play the role of connecting recovering persons to services that the recovering person may have limited access to, such as food stamps and medical care.<ref name=":4">{{Cite journal|last1=Heslin|first1=Kevin C.|last2=Andersen|first2=Ronald M.|last3=Gelberg|first3=Lillian|date=2003-01-01|title=Case Management And Access To Services For Homeless Women|journal=Journal of Health Care for the Poor and Underserved|volume=14|issue=1|pages=34–51|doi=10.1177/1049208902238822|pmid=12613067|issn=1049-2089}}</ref><ref>{{Cite journal|title=Services to domestic minor victims of sex trafficking: Opportunities for engagement and support|pages=1–7|journal=Children and Youth Services Review|volume=54|doi=10.1016/j.childyouth.2015.04.003|date=July 2015|last1=Gibbs|first1=Deborah A.|last2=Hardison Walters|first2=Jennifer L.|last3=Lutnick|first3=Alexandra|last4=Miller|first4=Shari|last5=Kluckman|first5=Marianne}}</ref> Others who have experienced similar difficulties and are on a journey of recovery can also play a role in establishing community and combating a recovering person's feelings of isolation.<ref name=":0" /> An example of a recovery approach that fosters a sense of community to combat feelings of isolation is the [[safe house]] or [[transitional housing]] model of rehabilitation. This approach supports victims of trauma through a community-centered, transitional housing method that provides social services, healthcare, and psychological support to navigate through and past experiences. Safe houses aim to support survivors on account of their individual needs and can effectively rehabilitate those recovering from issues such as sexual violence and drug addiction without criminalization.<ref name="NYU Press">{{Cite book |url=https://www.jstor.org/stable/j.ctv12fw97b |title=The Politicization of Safety: Critical Perspectives on Domestic Violence Responses |date=2019 |publisher=NYU Press |isbn=978-1-4798-0564-8 |volume=10|jstor=j.ctv12fw97b }}</ref> Additionally, safe houses provide a comfortable space where survivors can be listened to and uplifted through compassion.<ref>{{Cite journal |last=Harrington |first=Carol |date=November 2019 |title=Neo-liberal Subjectivity, Self-branding and 'My Rape Story' YouTube Videos |url=http://journals.sagepub.com/doi/10.1177/0896920518778107 |journal=Critical Sociology |language=en |volume=45 |issue=7–8 |pages=1181–1194 |doi=10.1177/0896920518778107 |s2cid=149930006 |issn=0896-9205|url-access=subscription }}</ref> In practice, this can be accomplished through one on one interviews with other recovering persons,<ref name=":0" /> engaging in communal story circles,<ref name=":0" /> or peer-led support groups.<ref name=":5">{{Cite journal|last1=Huntington|first1=Nicholas|last2=Moses|first2=Dawn Jahn|last3=Veysey|first3=Bonita M.|date=2005|title=Developing and implementing a comprehensive approach to serving women with co-occurring disorders and histories of trauma|journal=Journal of Community Psychology|language=en|volume=33|issue=4|pages=395–410|doi=10.1002/jcop.20059|issn=0090-4392}}</ref> Those who share the same values and outlooks more generally (not just in the area of mental health) may also be particularly important. It is said that one-way relationships based on being helped can actually be devaluing and potentially re-traumatizing,<ref name=":3" /> and that [[reciprocity (social psychology)|reciprocal]] relationships and mutual support networks can be of more value to [[self-esteem]] and recovery.<ref name="InclusionRecovery"/><ref name=":0" /><ref name=":2" /><ref name=":1" />

===Hope===

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===Empowerment and building a secure base===

Building a positive culture of healing is essential in the recovery approach. Since recovering is a long process, a strong supportive network can be helpful.<ref>{{cite journal | last1=Jacobson | first1=Nora | last2=Greenley | first2=Dianne | title=What Is Recovery? A Conceptual Model and Explication | journal= Psychiatric Services| volume=52 | issue=4 | year=2001 | issn=1075-2730 | doi=10.1176/appi.ps.52.4.482 | pmid=11274493 | pages=482–485| s2cid=2624547 }}</ref> Appropriate [[house|housing]], a sufficient [[income]], freedom from [[violence]], and adequate access to [[health care]] have also been proposed<ref>{{cite web | title=HE WINDOWS OF OPPORTUNITY for Mental Health Reform in Ontario | nameurl="OntarioRecovery"https://ontario.cmha.ca/wp-content/uploads/2010/03/cmha_ontario_windows_of_opportunity_201003.pdf?utm | access-date=2025-04-06}}</ref> as important tools to empowering someone and increasing her/histheir self-sufficiency.<ref name=":0" /><ref name=":4" /><ref name=":3" /><ref name=":6">{{Cite journal|last1=Gibbs|first1=Deborah A.|last2=Hardison Walters|first2=Jennifer L.|last3=Lutnick|first3=Alexandra|last4=Miller|first4=Shari|last5=Kluckman|first5=Marianne|date=2015|title=Services to domestic minor victims of sex trafficking: Opportunities for engagement and support|journal=Children and Youth Services Review|language=en|volume=54|pages=1–7|doi=10.1016/j.childyouth.2015.04.003}}</ref> [[Empowerment]] and [[self-determination]] are said to be important to recovery for reducing the social and psychological effects of stress and trauma. Women's Empowerment Theory suggests that recovery from mental illness, substance abuse, and trauma requires helping survivors understand their rights so they can increase their capacity to make autonomous choices.<ref name=":0" /><ref name=":6" /> This can mean develop the [[confidence]] for independent [[assertive]] [[decision making]] and help-seeking which translates into proper medication and active [[self care]] practices. Achieving social inclusion and overcoming challenging [[social stigma]] and [[prejudice]] about mental [[mental distress|distress]]/[[mental disorder|disorder]]/[[neurodiversity|difference]] is also an important part of empowerment. Advocates of Women's Empowerment Theory argue it is important to recognize that a recovering person's view of self is perpetuated by stereotypes and combating those narratives.<ref name=":0" /> Empowerment according to this logic requires reframing a survivor's view of self and the world.<ref name=":0" /><ref name=":1" /> In practice, empowerment and building a secure base require mutually supportive relationships between survivors and service providers, identifying a survivor's existing strengths, and an awareness of the survivor's trauma and cultural context.<ref name=":3" /><ref name=":0" /><ref name=":1" /><ref name=":5" />

==Concepts of recovery==

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What constitutes 'recovery', or a recovery model, is a matter of ongoing debate both in theory and in practice. In general, professionalized clinical models tend to focus on improvement in particular symptoms and functions, and on the role of treatments, while consumer/survivor models tend to put more emphasis on [[peer support]], empowerment and real-world personal experience.<ref>{{cite journal |author=Bellack AS |title=Scientific and consumer models of recovery in schizophrenia: concordance, contrasts, and implications |journal=Schizophr Bull |volume=32 |issue=3 |pages=432–42 |date=July 2006 |pmid=16461575 |pmc=2632241 |doi=10.1093/schbul/sbj044 }}</ref><ref>{{cite journal |title=Recovering from Illness or Recovering your Life? Implications of Clinical Versus Social Models of Recovery from Mental Health Problems for Employment Support Services |journal=Disability & Society |volume=17 |issue=4 |pages=403–418 |date=June 2002 |doi=10.1080/09687590220140340 |author1=Secker, J |author2=Membrey, H |author3=Grove, B |author4=Seebohm, Patience. |s2cid=144793249 }}</ref><ref>Carlos Pratt, Kenneth J. Gill, Nora M. Barrett, Kevin K. Hull, Melissa M. Roberts (2002) ''Psychiatric Rehabilitation''</ref> "Recovery from", the medical approach, is defined by a dwindling of symptoms, whereas "recovery in", the peer approach, may still involve symptoms, but the person feels they are gaining more control over their life.<ref>{{cite journal |last1=Stuart |first1=Simon Robertson |last2=Tansey |first2=Louise |last3=Quayle |first3=Ethel |title=What we talk about when we talk about recovery: a systematic review and best-fit framework synthesis of qualitative literature |journal=[[Journal of Mental Health]] |date=20 September 2016 |volume=26 |issue=3 |pages=291–304 |doi=10.1080/09638237.2016.1222056|pmid=27649767 |s2cid=4426778 |url=https://www.pure.ed.ac.uk/ws/files/26692801/160710_Stuart_et_al._Recovery_SR_for_PURE_with_cover_page_figure_and_tables.pdf |hdl=20.500.11820/84053d0a-9b25-47ff-9bdb-963bf6c70312 |hdl-access=free }}</ref> Similarly, recovery may be viewed in terms of a [[social model of disability]] rather than a [[medical model of disability]], and there may be differences in the acceptance of diagnostic "labels" and treatments.<ref name="InclusionRecovery"/>

A review of research suggested that writers on recovery are rarely explicit about which of the various concepts they are employing. The reviewers classified the approaches they found in to broadly "rehabilitation" perspectives, which they defined as being focused on life and meaning within the context of enduring disability, and "clinical" perspectives which focused on observable remission of symptoms and restoration of functioning.<ref>{{cite journal |title=Concepts of recovery: competing or complementary? |journal=Curr Opin Psychiatry |volume=18 |issue=6 |pages=664–7 |date=November 2005 |pmid=16639093 |doi= 10.1097/01.yco.0000184418.29082.0e |url=http://www.medscape.com/viewprogram/4828_pnt |vauthors=Davidson L, Lawless MS, Leary F |s2cid=28715315 |url-access=subscription }}</ref> From a [[psychiatric rehabilitation]] perspective, a number of additional qualities of the recovery process have been suggested, including that it: can occur without professional intervention, but requires people who believe in and stand by the person in recovery; does not depend on believing certain theories about the cause of conditions; can be said to occur even if symptoms later re-occur, but does change the frequency and duration of symptoms; requires recovery from the consequences of a psychiatric condition as well as the condition itself; is not [[linear]] but does tend to take place as a series of small steps; does not mean the person was never really psychiatrically disabled; focuses on wellness not illness, and on consumer choice.<ref>Anthony, W.A., Cohen, M., Farkas, M, & Gagne, C. (2002). Psychiatric Rehabilitation. 2nd edition. Boston: Boston University Center for Psychiatric Rehabilitation. {{ISBN|1-878512-11-0}}</ref>

A consensus statement on mental health recovery from US agencies, that involved some consumer input, defined recovery as a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential. Ten fundamental components were elucidated, all assuming that the person continues to be a "consumer" or to have a "mental disability".<ref>US Dept of Health and Human Services and SAMHSA Center for Mental Health Services (2004) [http://mentalhealth.samhsa.gov/publications/allpubs/sma05-4129/ National Consensus Statement on Mental Health Recovery] {{webarchive|url=https://web.archive.org/web/20080907014314/http://mentalhealth.samhsa.gov/publications/allpubs/sma05-4129 |date=2008-09-07 }}</ref> Conferences have been held on the importance of the "elusive" concept from the perspectives of consumers and psychiatrists.<ref>{{cite journal |title=Recovery Movement Gains Influence In Mental Health Programs |journal=Psychiatric News |volume=38 |issue=1 |pages=10 |date=January 3, 2003 |url=http://pn.psychiatryonline.org/cgi/content/full/38/1/10 |archive-url=https://web.archive.org/web/20030802211827/http://pn.psychiatryonline.org/cgi/content/full/38/1/10 |url-status=dead |archive-date=August 2, 2003 }}</ref>

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===Recovery from substance dependence===

Particular kinds of recovery models have been adopted in [[drug rehabilitation]] services. While interventions in this area have tended to focus on [[harm reduction]], particularly through [[Opioid replacement therapy|substitute prescribing]] (or alternatively requiring total abstinence) recovery approaches have emphasized the need to simultaneously address the whole of people's lives, and to encourage aspirations while promoting equal access and opportunities within society. Some examples of harm reduction services include overdose reversal medications (such as [[Narcan]]), substance testing kits, supplies for sterile injections, HIV, HBV, and HCV at-home testing equipment– and trauma-informed care in the form of group therapy, community building/events, case management, and rental assistance services.<ref>{{Cite journal |url=https://academic.oup.com/sw/article-lookup/doi/10.1093/sw/49.3.353 |access-date=2023-04-27 |journal=Social Work |doi=10.1093/sw/49.3.353 |title=Harm Reduction: A New Perspective on Substance Abuse Services |year=2004 |last1=MacMaster |first1=S. A. |volume=49 |issue=3 |pages=356–363 |pmid=15281690 |url-access=subscription }}</ref> The purpose of this model is to rehabilitate those experiencing addiction in a [[holistic]] way rather than through law enforcement and criminal justice-based intervention which can fail to address victims’ circumstances on a need-by-need basis.<ref name="NYU Press"/> From the perspective of services the work may include helping people with "developing the skills to prevent relapse into further illegal drug taking, rebuilding broken relationships or forging new ones, actively engaging in meaningful activities and taking steps to build a home and provide for themselves and their families. Milestones could be as simple as gaining weight, re-establishing relationships with friends, or building self-esteem. What is key is that recovery is sustained.".<ref>[http://www.scotland.gov.uk/Publications/2008/05/22161610/5 The Road to Recovery: A New Approach to Tackling Scotland's Drug Problem] by the Scottish Government, May 29, 2008</ref> Key to the philosophy of the recovery movement is the aim for an equal relationship between "Experts by Profession" and "Experts by Experience".<ref>{{cite book|last=Drew|first=Emma|author-link=Emma Drew|title=The Whole Person Recovery Handbook}}</ref>

=== Trauma-Informed Recovery ===

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Some US states, such as [[California]] (see the [[California Mental Health Services Act]]), [[Wisconsin]] and [[Ohio]], already report redesigning their mental health systems to stress recovery model values like hope, healing, empowerment, social connectedness, human rights, and recovery-oriented services.<ref>{{cite journal |vauthors=Jacobson N, Greenley D |title=What is recovery? A conceptual model and explication |journal= Psychiatric Services|volume=52 |issue=4 |pages=482–5 |date=April 2001 |pmid=11274493 |doi=10.1176/appi.ps.52.4.482|doi-access=free}}</ref>

At least some parts of the [[Canadian Mental Health Association]], such as the [[Ontario]] region, have adopted recovery as a guiding principle for reforming and developing the mental health system.<ref name="OntarioRecovery">{{cite web | title=MHCC releases recovery-oriented guidelines | website=CMHA Ontario | url=https://wwwontario.mindfulnesscontentcmha.comca/blognews/essentialmhcc-resources-for-personalreleases-recovery-andoriented-self-empowermentguidelines/?utm |title= access-date=2025-04-06}}</ref>

Breaking Barriers: Essential Resources for Personal Recovery and Self-Empowerment

| website= mindfulnesscontent.com }}</ref>

===New Zealand and Australia===