Why recovery-based care?
Recovery-based care is founded on the client's definition of what it means to be "in recovery." It promotes hope, empowerment, connection and healing. Recovery-based care moves away from a biomedical approach and helps clients re-establish losses related to their mental health or addiction issues and reclaim their lives as independent members of society.
The video Nick's Goals within REACH carries a message of resilience and recovery. After experiencing difficulty in school due to mental illness and problem drug use, Nick Carveth enrolled in the REACH (Recovery and Education for Adolescents Choosing Health) program at the Centre for Addiction and Mental Health, which helps youth work on education goals while in treatment.
Definition
Recovery refers to the ways in which people with mental health or addiction problems experience their lives by focusing on positives: health, hope, choices, equity, respect, supports and improved quality of life.
More specifically, recovery is about:
- empowerment (having control over one's life)
- self-determination and personal responsibility
- having one's expertise valued
- reaching one's potential
- engaging in meaningful activities, such as education and work
- being included in community life
- having a voice in treatment plans.
Balancing risk
Recovery-oriented systems advocate for clients and educate the community that people with mental health and addiction issues can lead healthy lives. Recovery is not always a linear process. It involves learning from setbacks and moving forward. Recovery does not necessarily mean that people will never again experience symptoms, go through hard times or relapse. Accepting that the recovery approach to care involves a level of risk for care providers and clients needs to be part of the recovery journey.
Principles of recovery-based care
Stigma and discrimination are barriers to recovery for people with mental health and addiction issues. Recovery-based care reduces those barriers. It is built on 10 guiding principles:
- Self-direction: People determine their own path to recovery.
- Client-centred approach: Care is based on each person's strengths, needs, preferences and experiences.
- Empowerment: People can choose among options and participate in all decisions that affect them.
- Holistic perspective: Recovery focuses on people's entire lives, including mind, body, spirit and community.
- Non-linear process: Recovery is not a step-by-step process. It involves continual growth, occasional setbacks and learning from experience.
- Strengths-based approach: Recovery builds on each person's strengths.
- Peer support: Mutual support plays an invaluable role in recovery.
- Respect: People with mental health and addiction problems are accepted and appreciated by society, communities, systems of care and other consumers.
- Responsibility: People are responsible for their own self-care and recovery journeys.
- Hope: The central message of recovery is that people can and do overcome obstacles.
Collaboration
Collaboration between clients, care providers and external partners supports clients throughout the recovery process. It helps to facilitate clients' reintegration into the community.
Care providers work with clients and families (if the client agrees) to establish treatment and recovery plans. They build on clients' hopes, strengths, interests and goals to help clients develop the skills and knowledge they need to gain a sense of control over their mental health or addiction issues.
To support clients on the road to recovery, care providers need:
- guidance and training on how to respond to clients' unique experiences
- support to respond to clients' preferences with appropriate risk management
- direction around how to include family members in discussions about recovery.
Related approaches
- client-centered care
- trauma-informed care.
Evidence summary
2004 National Consensus Conference on Mental Health Recovery and Mental Health Systems Transformation. (2012). Recovery principles. Monitor on Psychology, 43(1), 55.
Department of Health (Victoria, Australia). (2011). Framework for Recovery-Oriented Practice. Melbourne, Australia: Author.
O'Grady, C. & Skinner, W.J.W. (2007). A Family Guide to Concurrent Disorders. Toronto, ON: Centre for Addiction and Mental Health.
Resources
Online
- The Ohio Department of Mental Health has developed the Emerging Best Practices in Mental Health Recovery website. You can find information about guiding principles of best practices, as well as training for your organization in using best practices.
- Mental Health Consumer Providers: A Guide for Clinical Staff shows agencies how to strengthen or expand the involvement of people with mental health issues. It also describes how people can get involved as advocates in mental health care. The guide was developed by the Rand Corporation, a U.S.-based public policy research organization.
- The Sainsbury Centre for Mental Health in the United Kingdom produced Making Recovery a Reality, a policy paper that examines the principles of recovery, the skills it requires and obstacles to implementing recovery-orientated practice.
- The Mental Health Commission of Canada developed Toward Recovery and Well-Being, which outlines a framework for a mental health strategy for Canada.
- 100 Ways to Support Recovery: A Guide for Mental Health Professionals was developed by Rethink Mental Illness in the United Kingdom. It identifies 100 ways in which people working in the mental health field can support the recovery of people with mental health problems.
For your clients and their families
- Here to Help is a project of B.C. Partners for Mental Health and Addictions Information. It provides information about mental health and addiction for clients and the general public.
- The Illness Management and Recovery Scale: Client Self-Rating developed by San Diego State University and the University of California San Diego is a self-rating scale that measures potentially valuable recovery-oriented mental health outcomes.
Training
- The Recovery-Oriented Approach Online Course is intended for mental health, addiction and allied health professionals who have completed the Concurrent Disorders Core Course and have experience working with clients who have concurrent disorders. The course teaches people how to work from a recovery-oriented approach.
A story
Hope in recovery: There is life after a diagnosis of mental illness
by Chris Summerville
For many, learning that one has schizophrenia is like receiving a "kiss of death" diagnosis. The history of our understanding – or lack of understanding – about severe mental illnesses like schizophrenia is, for the most part, encapsulated in this grim sentence handed down by psychiatrists and others – "poor prognosis with progressively downhill course." The DSM-IV [DSM-5 released in May 2013], the standard tool for diagnosing schizophrenia and other mental illnesses in North America, describes the illness with such dark, devastating language that it is easy to think that any sense of hope is a delusion.
But for most people, schizophrenia does not seem to be an illness of slow, progressive deterioration. Researchers have found that even in the third decade of illness, the potential for full or partial recovery remains. For the past 25 years, people with mental illness have been sharing their stories of their struggle through and recovery from or in mental illness. As one woman with schizophrenia recently told me about her recovery progress, "It's like a resurrection!"
These words capture the essence and hope of the recovery model. This model is being embraced at the national level, where the Mental Health Commission of Canada (MHCC) recently completed its first round of consultations for a mental health strategy, proposing that the first guiding value or principle be "The hope of recovery is available to all." Canadians are finally discussing the concept, which has been realized in the recovery-oriented mental health strategies of countries like New Zealand, Australia, Scotland, England and the United States.
