Hello! Coming at you with a post about a concept that I only learnt about recently, as it forms the basis of mental health support at the charity I work for- and that's the Recovery Model.
What is Recovery?
Firstly- what is recovery? Defined by the dictionary, it's 'the process of combatting a disorder' (Merriam-Webster, no date). There's a lot of things I personally don't like about this definition- the use of 'disorder' is very clinical, and what does 'combatting' look like? Additionally, in mental health this might look quite different in comparison to physical health. Instead of looking to achieve a state of health with a total absence of illness or symptoms, mental health recovery could instead look to achieve a state of functioning, coping or progress- or could more closely align with the World Health Organisation definition of health: "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" (WHO, no date). This definition recognises the holistic components needed to recover and achieve a state of health, and also recognises that health can be achieved even whilst living with a mental health condition. For example, someone will likely live with a condition like schizophrenia for life, but can control the symptoms to a point where their condition does not impact on their health or functioning.
Typically, recovery will be a journey, as we recognise that it's not something that happens overnight and that it's a non-linear process, with setbacks and relapses likely to occur along the way. In the wise words of Rascal Flatts, life is a highway, and we're gonna ride it all night long.
For me, my recovery from complex PTSD looks like being able to work regularly, doing less than full time hours, not needing crisis services, staying out of hospital, and being able to manage my medication safely and independently. I fully recognise that my start point, before trauma, and my end point of recovery will be vastly different. I cannot get back to the person I was before becoming unwell, because that would mean erasing experiences and memories that fundamentally changed me as a person. The end point isn't necessarily worse, just different.
What is the Recovery Model?
The Recovery Model is an approach developed in the 1980s and 90s which sets out a social framework for personal recovery- as opposed to clinical recovery. As stated above, this approach can be used within mental health systems to recognise that an absence of symptoms may not be the most appropriate outcome for people. Instead, this model focuses on people identifying what a meaningful recovery looks like for them. It also recognises that a clinical model, which may focus on diagnosis and medication, can be useful alongside a social model to achieve comprehensive support to facilitate recovery. Rethink explain the difference and overlap between clinical and personal recovery really nicely.
It's also really important to recognise that social determinants of health can have massive impacts on someone's mental health and ability to recover. Someone living with a huge amount of debt is unlikely to be able to rid themselves of anxiety until the debt is cleared. Someone who is struggling with depression may find that their depression is due to living in a situation with domestic violence, hence the depression is unlikely to go away until their living situation has changed and they can have physical and psychological safety. In his book 'The Health Gap', Michael Marmot (my hero) described this exact situation- '
Bill Anthony is considered to be a pioneer within the Recovery Model, and stated:
'Recovery is a deeply personal, unique process of changing one's attitudes, values, feelings, goals, skills and/or roles. It is a way of living a satisfying, hopeful and contributing life even with limitations caused by the illness. Recovery involves the development of new meaning and purpose in one's life as one grows beyond the catastrophic effects of mental illness'
(Anthony, 1993)
There's a huge amount I like about this quote, but the one thing I don't is the use of the word 'catastrophic'. I fully recognise that the effects of mental illness can be catastrophic, but it's important to recognise that this isn't universal. For example, for me, being admitted to hospital for my mental health was catastrophic, but the friends I made during that admission have been anything but. Everything else about this message I find really very hopeful.
Within my organisation, we approach recovery and support people in their recovery in 3 main ways- coaching to help people identify goals, such as starting to study on a course or getting back into paid employment, and supporting individuals to work towards these; learning through our local Recovery College to provide education and training on a variety of topics aligned with mental health to communities and businesses; and therapeutic activity in a group setting to help people to build routine, structure, confidence and skills. These 3 approaches all support a holistic, social view of recovery which seeks to empower people to have greater control over their life and illness.
Recovery Colleges are springing up around the country and typically operate on the premise that learning about mental health can provide hope for the future, opportunities to make changes, and increased control over your life as part of a personal recovery journey. Generally, courses will be co-designed and co-delivered by people with lived experience, to provide authentic knowledge about the topics being delivered. Most will strive to take a non-judgemental and trauma informed approach (for example, considering 'what happened to you?' instead of 'what's wrong with you?') and encourage sharing of your own lived experience to benefit yourself and others. Personally, I would highly recommend finding your local college and enrolling on courses- I've done several with ours, and consistently found them to be very safe spaces where I can develop my personal and professional knowlewdge and skills to be able to better support myself and others.
What makes up a Recovery Model?
There's a huge number of concepts and attributes that can be incorporated into a recovery model depending on where you look. For example:
Resillience, identity, self-esteem (Rethink Mental Illness, 2022)
Connectedness, hope & optimism, identity, meaning & purpose, empowerment- the CHIME model (Leamy et al., 2011)
Hope, dignity, self-determination, and responsibility (Eli's Place, 2022)
Often, the concepts within the Recovery Model overlap with concepts from AA (alcoholics anonymous) models, which promote recovery from substance misuse disorders. These are known as the '12 steps' and you can read more on that here.
Typically, these models promote a broader overview of health and recovery, that consider personal attributes and factors about a person outside of their illness. There is no hard and fast rule for what makes up a recovery model, but hopefully this post has helped you to reflect on how you can consider recovery more holistically and what you can bring into your own practice to support people in their recovery journies!
Love.
Christie x
References
Merriam-Webster (no date) Recovery. Available at: https://www.merriam-webster.com/dictionary/recovery. (Accessed 01/12/2024)
WHO (no date) Constitution. Available at: https://www.who.int/about/governance/constitution (Accessed 01/12/2024)
Anthony, W. (1993). 'Recovery from mental illness: The guiding vision of the mental health service system in the 1990s' in Psychosocial Rehabilitation Journal, 16(4), pp.11–23.
Rethink (2022) Recovery and mental illness. Available at: https://www.rethink.org/advice-and-information/living-with-mental-illness/treatment-and-support/recovery-and-mental-illness/ (Accessed 01/12/2024)
Leamy, M. et al. (2011) 'Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis' in British Journal of Psychiatry. 199(6), pp.445-52.
Eli's PLace (2022) Understanding the Recovery Model: How Is It Different From the Traditional Approach. Available at: https://www.elisplace.org/understanding-the-recovery-model-how-is-it-different-from-the-traditional-approach/ (Accessed 04/12/2024)
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