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.
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.
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.