Part 24 of The Mental Health Workers' Guide considers the meaning of recovery in mental health care. Don't forget that you can download the podcasts and video clips that accompany this series here.

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The mental health support workers’ guide 24: The meaning of recovery

What the professional bodies say…..

 “People can and do recover from severe mental health problems. Research studies have followed the progress of individuals with different mental health problems over several years. A large review of longitudinal research studies of those with schizophrenia found that complete recovery (a return to pre-illness levels of functioning) occurred in 20–25% of participants, and social recovery (regaining economic and social independence) in 40–45%.”

“We frequently do not know what is possible until we try.”

Recovery & rehabilitation:

a fair deal

RCPsych 2008

http://www.rcpsych.ac.uk/pdf/Fair%20Deal%20Manifesto%20%20Recovery%20and%20Rehabilitationx.pdf

“Individuals with chronic schizophrenia constituted a large proportion of all residents of mental institutions in the past, and still do where these institutions continue to exist. With modern advances in drug therapy and psychosocial care, almost half the individuals initially developing schizophrenia can expect a full and lasting recovery. Of the remainder, only about one-fifth continue to face serious limitations in their day-to-day activities.

Schizophrenia is found approximately equally in men and women, though the onset tends to be later in women, who also tend to have a better course and outcome of this disorder.”

World Health Organisation

The world Health Report 2001

Chapter 2

http://www.who.int/whr/2001/chapter2/en/index4.html

The three types of recovery

It’s important to be clear about what we mean by recovery. Many people would argue that there are actually three types of recovery and if a person can achieve any two of the three then they have recovered. The three types of recovery are:

Social recovery

This is to do with acceptance by the community in which a person lives. If the people around us don’t have a problem with us then we have achieved social recovery. We become productive members of our society and contribute to the social structure around us.

Psychological recovery

If we are not distressed by our ‘symptoms’ then there is no psychological (or emotional) problem. This is known as psychological recovery.

Medical recovery

This is to do with the signs and symptoms which doctors use to diagnose mental illness. If we are free of symptoms of mental disorder then we can be said to have recovered – so long as the symptoms do not return. This is why mental health professionals who are interested in recovery work hard on ‘relapse prevention’. If a person never has a relapse of their mental health problems then that must equal recovery.

What this means

Many would argue (as I do) that any two of the three will be sufficient for meaningful recovery. To say otherwise would be to deny the experiences of priests and mediums, shamans and spiritualists the world over. It matters little whether they are psychotic or not. What matters is that they have a place in the world, can function appropriately within society and are not distressed or incapacitated by their experiences.

If we accept only the limited ‘medical’ view of recovery we are likely to fail spectacularly. It may be that we will succeed in using antipsychotic medication to remove hallucinations but along the way we may well tranquilise the person so much that all meaningful thought ceases. In short we remove one first rank symptom (hallucination) but create another (thought disorder).

It’s far more effective and humane to work on helping the person to function.

Deal with individuals, not labels

See also:

Harrison G. et al (2001)

Recovery from psychotic illness:

 a 15 and 25 year international follow up study

British journal of Psychiatry

Number 178 pp.506-517