Like any field, Mental Health has its own language and uses certain words in specific ways. If you’re new to the field, this can be confusing and frustrating. If you’re currently on the fringes of the Mental Health field, you will probably have heard the word recovery banded about a bit, with no one ever really explaining what it means. In the general culture, to have recovered from something means you’re completely better, cured. The recovery model uses the word in a different way, to mean that people with Mental Illnesses still have something to offer, still have rights, and can still live meaningful lives – whether they get completely better, live with and manage their condition, or remain very unwell. The recovery model was moving away from some of the issues with the medical model. Like anything, some people like it and some don’t. I like the model itself a lot, but the way it is implemented can leave something to be desired. Unfortunately, I don’t think we’re ever going to find models that are so perfectly designed we can’t screw them up.
What is a recovery focused service supposed to look like? There’s some great ideas and articles about this out there. I like the work of Marianne Farkas, who in this article sums up the recovery approach into four main values.
This means not seeing people just as ‘sick’ or mentally ill, but recognising that outside of that role, they are whole people with many different characteristics. This is very important to me, whenever I have a new worker of some kind of in my life, the relationship begins very role-bound. As quickly as I can I move towards a relationship that has two unique people in it, rather than a ‘service provider’ and ‘service user’. By that I don’t mean that it becomes inappropriate or unprofessional. Rather, that I am seen as more than just ‘someone with a mental illness’ and we move away from that unpleasant dynamic of me needing help and having no answers, and them having all the answers and needing no help. I’m always more comfortable when there are two humans in the room!
Person involvement means including me in all stages of services, how they are planned, created and delivered. The ‘patient’ role favoured by the medical model is a very passive one, I as the patient go in for treatment and hopefully come away cured. My job is to turn up on time and follow instructions. In mental health this passivity is painfully destructive. Firstly, selling the idea to people than someone else can fix your mental illness is cruel. Recovering from a mental illness is an active affair! No one can pluck it out of you. The more you engage, the more you learn about your situation, and develop awareness of what works for you, what makes you worse, what keeps you stable and well, the better the outcome often is. That doesn’t mean doing this alone! But a passive patient in mental health can give no useful information to the people who work with them. The service providers are ‘flying blind’ and reduced to guesswork about what the person needs and what approach might work. Collaboration, where you are in the drivers seat as much as possible, and their role is support you, encourage you, keep you safe, and help you access resources, that is about recovery.
Self Determination
This means having choices! The right to choose one service over another, to refuse services that you don’t like, and to be allowed opinions about your own care. The medical model doesn’t just invite a passive approach, it often requires it and punishes any other response. People are assessed on the basis of their ‘treatment compliance’, how submissive and agreeable they are. Being labelled as ‘non-compliant’ can cause you major problems with getting help, doctors may refuse to treat you or hospitals to admit you, you may have problems with Centrelink, and the public health system is not geared towards choice – staff rotate on their own rosters and you don’t have much power to request to stay with someone you got along with. In fact trying to access the same person can be interpreted as attempting to ‘manipulate’ the system and be another ‘non-compliant’ act, even though most of us understand that good rapport is important and changing service providers regularly is very stressful and tends to result in fragmented care. Choice is about understanding that people are different, there are ‘horses for courses’ and allowing people to settle with providers and approaches that work for them.
Hope
Sadly, this is an easy value to lose. Those who constantly work with the most unwell, disadvantaged people can lose sight of hope. Carers or staff begin to think of all people with mental illnesses as being profoundly disabled. Discouragement sets in, and people with illnesses start to be set up for failure, being told things like ‘schizophrenia is a degenerative disease, you’re only going to get worse’, ‘it’s very unlikely you’ll ever be able to work again’, ‘you’re a hopeless case’. Despair and frustration characterise the conversation between service providers and users, and the level of animosity can become very deep and very entrenched. Hope isn’t supposed to be naivete, but an awareness that things can change for all of us. The most profoundly unwell person still has growth potential! And those of us doing great have the potential for illness. Current roles of ‘well’ and ‘sick’ are not permanent, they may even be exchanged over time. This awareness helps us to interact in a more humble and respectful manner. People can remain stuck and overwhelmed for many years before something clicks inside. I know people who’ve spent many years in hospital and been told they would never recover who are now living independently. Things can change, roles can change, and service provision should always be about nurturing that potential for growth, not making the environment so hostile and depressed that it has little chance of taking root.
I’m pretty keen on all these ideas and I’d love to see more of all of them in our services. In my experience, we’re using the terms but not always understanding just how profound the power shift is supposed to be. There’s still a long way to go in improving the quality of mental health services and developing systems that are designed to be flexible, adaptive and responsive to individual needs. At the moment we often have systems that are limited and restricted, with some awesome people struggling to work within them. Getting your degree – or diagnosis, can be like being invited to a war. You’re given your uniform and told what side you’re on, and from that point forwards everything is ‘them’ and ‘us’, and no one is rewarded for seeing the other point of view. There is a better way, and I think recovery values are part of this.
Sarah K Reece 
Reblogged this on Darque Thoughts.
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Hi,
I agree, concepts like compliance and treatment resistance can easily lend themselves to replaying abusive dynamics with people who've come through trauma. If being obedient and docile is required before you can access what you need, the sense of being powerless is terrible. I'm excited by different approaches that reduce the power imbalance and respect people's individuality and rights to have choices and opinions of their own. It's heartbreaking when mental health services (often with the best of intentions!) end up role playing and reinforcing abusive dynamics instead of supporting people to find their own strength and hope and voice. Thanks for sharing your perspective.
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Hi Sarah, I think the compliance model you mention is ultimately destructive and disempowering in relation to trauma survivors. It effectively places you back in the role of a child. It can replicate the dysfunctional dynamics that occur in abusive families. Either you are good or bad. You can be punished for both depending on the whims of your 'caregivers.' I have always been compliant, seeking to gain the nurturing I never had; that I thought was withheld because I was bad. As a strategy compliance doesn't work if you fail to improve. You then become merely treatment resistant. Thereby institutionalising 'your' failure. Hope is lost and your essential badness is reinforced.
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Hi Stephen, Happy new year to you too! That's awesome, sounds like you are building some great networks now. It might be slow, but it all adds up. 🙂
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Hi Sarah, happy new year!
I am very familiar with ACEDA and regularly went to the evening support group for a little over a year beginning in December 2009.
I am also very familiar with GROW, I went to a GROW group for around a year also beginning in July 2010, I still go to the socials and just got back from the new year's eve event (I saw on FB that you were interested in attending).
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Hi Stephen,
12 years is a really long time to be struggling and feeling like you're not making any progress. I'm sorry that it's been so hard for you to find good support and information. You're right, it takes more than motivation to recover. I also found Mifsa really helpful, and it saddened me when my GP at the time discouraged me when I said I planned to attend, telling me that spending time with other people with a mental illness would only make me sicker. Quite the opposite has happened!
Isolation is a huge problem for many people with a mental illness, me included. I have PTSD, which is a type of anxiety disorder and I've also struggled a great deal with isolation and loneliness. Not everyone with a mental illness has this problem, but it is a common one, even with other anxiety disorders such as Agoraphobia, and as you say, it makes recovery very difficult.
Have you heard of Aceda? They are a local organisation providing support for all types of anxiety and eating disorders. You may also find GROW interesting to check out, they are a group of people with different mental illnesses who meet regularly, partly with the aim of reducing isolation.
This isn't off topic for my blog at all, I'm passionate about recovery and improving support for all people with any mental illnesses. I have a particular focus on dissociation and trauma recovery as I have those issues myself and am aware of the lack of information and support for them, but my focus is also much broader, and I'm very interested in how psychiatric disabilities relate to the wider disability field and what we can learn from each other there too.
It's a tough road for many people with mental illnesses, some of us get more 'help' than we want, while others of us are left to flounder by ourselves. Resources are patchy and there are often many conditions you have to meet to access them such as what postcode you live in.
I understand your position on medication too, when there are obvious deficits in our lives causing us distress the medication option may not make much sense. It is possible that medication may help to reduce some of the anxiety you feel so that it's easier to rebuild and reconnect socially, but that can be a difficult road with a lot of trial and error too, so I respect your decision not to engage it at this time.
I'm glad that you feel things are starting to improve for you, every little bit makes a difference. Yes, there are many people like me trying to make the world a better place. 😀 Good intentions don't always translate into effective help, but there's a lot of good people doing their best to listen and care. Good luck with your efforts to reconnect socially and I hope you continue to make progress in reducing the effects of anxiety in your life.
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Thanks for your reply Sarah.
I don't think I was actually on the path to recovery at all until I happened to be assigned a knowledgeable Job Network case manager. She was the one who gave me a brochure for MIFSA, have me come up with a list of interests and sent me a website link to a local concert band (which I used to become involved in music again).
I think I starved for lack of knowledge from age 17, when my life had pretty much gone down the drain, until age 29 (I'm 31 now). Despite having a desire to turn things around. There was no choice with my “self-managed” recovery due to a complete lack of a support network from age 13 to present.
So the ball didn't get rolling on my recovery until I finally had a venue available for being around people in a non-judgemental on a regular basis (MIFSA). I did try full time work, study and volunteer work in the intervening years but that didn't involve enough interaction to really start progressing with my people-related issues. But with recovery starting so late (I remind myself to be thankful it started at all), a great deal of my current problems are due to a decade plus of isolation. This is the terrible trap many people with social anxiety can fall into for your information, the people who suffer from other types of anxiety generally tend to have a support network and friends, spouses etc. I hope this isn't off-topic for your blog which focuses on dissociation.
I agree with you about the rehab analogy but someone without any knowledge about how to rehabilitate themselves, even if they have the desire to, will not get very far very quickly. Or even if they have worked out the “what” they may not know the “where” or “how” (eg. I need to interact with people more, but how do I go about that and where can I go?).
I have tried to focus on the root causes of my problems but sometime they can seem so numerous and so deep that it's hard to get started. I never liked the idea of medication as that would leave my situation unchanged. I would not suddenly be surrounded by people who were supportive and concerned for my welfare if I went on a course of medication of dubious helpfulness.
Sorry for the length of this reply but there's so many themes here it's hard to write a short and succinct one where I don't begin to launch into my life story. I find it reassuring that you are willing to reply to your commenters in such detail and always with a supportive attitute, it lets me know that there are decent people out there trying to make the world a better place.
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Hi Stephen, thanks for your comments. People reply to my blog posts either in public by leaving comments, or privately by sending me an email if they'd prefer not to have anyone else reading their thoughts. Both are fine of course! If you ever write anything you have second thoughts about for some reason, you can always ask me to remove it, I've done that before when asked. 🙂
The Recovery Model was developed for any setting in which people with a mental illness are being engaged – hospitals, community centres, therapy, any context. Some organisations have adopted the model, to greater or lesser extents. Some places think they operate from the recovery framework and use the term “recovery” but don't necessarily understand or use the values from the Recovery model, which adds a lot to the confusion. Settings that primarily use the medical model may combine a bit of both.
The thing with mental illness is that for most people, you can't just submit yourself and have someone else 'fix' things you way you can with a broken leg. It's more like rehab in that you're the one who does the work, hopefully with the support and guidance of some people with good experience. So a self-managed approach can actually be far more effective in recovering from a mental illness than hopelessly presenting yourself to the services with the mistaken belief that they can make everything better. The advantage too of self management is that you can pick and choose programs and approaches that work best for you – when someone else is making all those calls it's often a bit hit and miss as they try to work out what best suits you, often in a context of having many other people they're also trying to support.
Having said that, always trying to show your most functioning side and never getting good support for distressing problems is a really tough place to be in. It often takes more than one try to find the kind of support that's going to be really helpful, and approaches that are a good fit. I've also found personally, that therapy and mental health support are not good substitutes for having mates, stable housing, meaningful activities, good health, and all those other things that contribute to our good mental health. Sometimes working directly on mental health problems is targeting the symptom rather than big underlying issues like housing stress – of course the reverse is also true and sometimes we focus on external issues when the internal ones are really needing attention.
I hope you feel that your approach is working for you and that you're making some progress with the issues you described. Take care!
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Some interesting insights. I think you may have unintentionally omitted what settings the above models are employed in.
My first contact with seeking help was to visit the counsellors at Flinders Uni beginning in 1998 as I had issues and they were there. They just gave me some basic information and that was about it.
I later tried seeing a psychologist but we didn't really have a productive relationship. To my knowledge (even at present) there wasn't a place I could simply submit myself to and say “help me”. Maybe it doesn't really work that way for people with social anxiety issues.
Maybe I like to think of myself as normal as long as people aren't around so haven't really sought out help the way someone who eg. is hearing voices might.
My recovery is still self-managed, I put myself on a program of activities after finding out about MIFSA and getting the ball rolling there.
Even my PHaMS relationship seems to be highly self-managed, I'm not sure if this repeated dynamic is all due to me (probably is now that I think about it)I generally try to demonstrate my functionality despite some pretty serious problems with lack of social skills, verbal skills, anxiety in public and with socialising, depression, defeatism, poor sleep etc.
I got caught up in my reply a bit but I hope this is the sort of reply bloggers like, I new to reading someone else's blog and making comments.
It was a well crafted blog entry so thanks for spending the time to write it.
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Thanks, what a good idea! Hadn't thought of that.
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Back to read it again. I think this would make a great pamphlet for people to pick up to explain what a recovery based service is aiming to do.
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Why, thankyou! 🙂
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Hi. Your prose is stellar and the pictures adorable!
A helpful explanation of recovery.
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