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The “Recovery” Principle

It seems that mental health thrives on buzzwords. At one time, everyone was talking about the word, “user” to be preferred to the word “patient”, it being believed that the word was more “empowering” (another commonly used word) and also that “community care” was to take over from the hospital system that sidelined people with a mental illness diagnosis. Also, amongst some service user groups, the term “mental illness” itself has been rejected and replaced with concepts such as “emotional distress” which are considered by them to be friendlier and less anxiety-provoking and judgemental.

In recent years, a new word has come into the fray. Starting in small ways in the realm of theory, it has spread into every area of the mental health system and, what's more important, has had widespread effects on policy and service provision. That word is “recovery”.

“Recovery”, is a positive word, according to its supporters. It is proactive-sounding and when applied to such things as the names of organisations and projects and when used in policy statements it seems to have a ring of hope and decisive action for the better in the lives of real people. After all, if we have illness problems, don't we all want to recover from them? Also however there should be a word or two of warning. It all seems well and good, but there is the ever-present danger of abuse, misuse and misunderstanding around any term.

Recovery has two clear meanings when it comes to its use in mental health, the first is obvious, that is as in recovery from an illness, in the medical sense, that is getting better, or even being “cured” of one's problems leading to recovery. Though this is possible, it has to be said that in the current state of things it is unlikely for a lot of people suffering from problems such as long term depression or schizophrenia. A potential problem is that this idea has such a good sounding ring to it in these contexts and could lead to people who have not experienced the mental distress caused by illness in themselves or others to think that cure is often possible and even easy. If we are to be realistic, though our ultimate goal is full recovery in this sense of the word, we often have to settle for another definition.

This second definition is recovery as in getting something back or in “recovering” it. “Rethink” the mental health charity seems to have opted for this second definition, saying that they want to help people affected by mental health issues to “recover a better quality of life”. On the face of it this would seem to be more of a social definition and less strictly medical. It also seems to hold out hope of easier progress, or even the possibility of progress at all. It seems to help service users and the mental health workers who work with them to focus on the possibility of positive development and sets a goal (or goals) to which they can aspire and aim for. However distant the final hope seems, steps can always be taken towards that goal of recovery of something that was once a real good and could be so again.

One central plank of the mental health system as it now exists, is the care plan approach or CPA. A plan, however basic and modest gives, it is argued, a framework around which care provision can be built and which improves the chance of progress. Now we are getting a notion of “recovery plans” . A recovery plan can employ all the ideas of getting the better quality of life back that once existed for the client or user so it can be optimistic, goal centred and realistic which makes it very attractive as an idea.

So recovery seems like a superb idea, helping people to sort their lives out, giving a positive and developmental slant to process and planning and holding out real hope to those with problems. But what is the reality of this hopeful word and its implication in real lives for those with the problems of mental distress that are sometimes caused by illness?

Recovery, as well as being a positive concept, is also a challenging one. Though it is a happy-sounding word, it is also demanding, a strong word that should be used sparingly if it is to gain maximum effect. It has become all to common to shove the word in everywhere and expect it to have some magical curative property and in the end a word is just that, only a word. It can be misused, often with good intent and can lead to over-forceful approaches towards developmental work with service users. It is true that a certain amount of challenge and even force can have its value, but this always needs to be informed by the particular situation and person and should never become a blanket approach to work when it sadly becomes a counterproductive idea. Real recovery is never easy, but it is worthwhile and though hard, gains results. It is here that the skills of the mental health worker and their sensitivity are paramount.

Recovery is demanding and can be daunting then. Also it may be unclear what recovery means for us, as there may be difficulty in establishing a specific goal, especially if distress has been real and hurting in a persons life for a very long time. Recovery still has its uses and if applied thoughtfully and well can produce achievement, but there needs to be a light at the end of the tunnel before one can aim for it. One central idea is then to find, establish and maintain a positive and realistic goal or recovery loses its thrust and meaning altogether and we are “back to square one”. In the everyday life in projects this can happen and must be guarded against. Small steps is one possible answer.

And what are we to say about the whole notion of caring? What can be done when the demands of recovery and those of care conflict with each other? It is utterly wrong to say that the notion of recovery has replaced that of care and sometimes care is needed first before sights can be set on recovery. It is ideal to hope and aim for the ultimate goals, getting back to work, removing symptoms entirely and becoming independent, but also care is needed because of the centrality of distress in the whole experience of the mental health recovery process. Recovery is the destination, but we need a gentle and supported route to it if it is to work out for many. Gentle yet persistent is the way with care and recovery going hand-in-hand.

So what are we to make of recovery as a word and as an idea? It is a word with much to commend it and has undeniably produced results in services. However, it is not the cure-all that there is a danger of it being seen as. When the old asylums were closed the word on everybody's lips was “community”. The reality of the situation was that for some, the hospital was the only community they had ever known and closing them was incredibly traumatic. There were mistakes and these led to some serious problems. The notion of recovery is, in a subtler way, just as big a change as the shift to community care. As such, the ideas around it must be well managed and sensibly applied as far as possible. There will never be one answer to the problems we face and recovery is not all of the answers. However, used well it can gain advancement and bring help to the people who really need it. Recovery is more than a word, it is a way of life, but needs to be applied with sensitivity, understanding and thorough thought if it is to be a help and not a bane.

By S. Hastie