Recovery model: Difference between revisions

Revision as of 19:20, 12 May 2023

Revision as of 19:29, 12 May 2023

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In [[medicine|general medicine]] and [[psychiatry]], recovery has long been used to refer to the end of a particular experience or episode of [[illness]]. The broader concept of "recovery" as a general philosophy and model was first popularized in regard to recovery from [[substance abuse]]/[[drug addiction]], for example within [[twelve-step program]]s.

Mental health recovery emerged in [[Geel#A_model_of_psychiatric_careA model of psychiatric care|Geel, Belgium]] in the 13th century. [[Dymphna|Saint Dymphna]]—the patron saint of mental illness—was martyred there by her father in the 7th century. [https://www.visit-geel.be/en/the-church-of-st-dymphna The Church of Saint Dymphna] (built in 1349) became a pilgrimage destination for those seeking help with their psychiatric conditions. By the late 1400s, so many pilgrims were coming to Geel that the townspeople began hosting them as guests in their homes. This tradition of community recovery continues to this day.

<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—211207–211 | doi = 10.1192/pb.bp.115.051631 | 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 | publisher = 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://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.

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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|s2cid=10319681|issn=1874-9240|url=https://semanticscholar.org/paper/9856565454f69384bdfe1906efa04a5ece89f867}}</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|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}}</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 2019-11 |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 |issn=0896-9205}}</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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===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|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 web |url=https://academic.oup.com/sw/article-lookup/doi/10.1093/sw/49.3.353 |access-date=2023-04-27 |website=academic.oup.com |doi=10.1093/sw/49.3.353}}</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>{{Cite book |url=https://www.jstor.org/stable/j.ctv12fw97b |title=The Politicization of Safety: Critical Perspectives on Domestic Violence Responses |date=2019 |publishername="NYU Press |isbn=978-1-4798-0564-8 |volume=10}}<"/ref> 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 ===