What is Recovery?

Along with Bill Anthony we define recovery as:

wanthonyA deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and roles. It is a way of living a satisfying, hopeful and contributing life, even with the limitations caused by illness.

Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness.’

(Anthony, 1993)

In the same paper, he went on to say: ‘Recovery from mental illness involves much more than recovery from the illness itself. People with mental illness may have to recover from the stigma they have incorporated into their very being; from the iatrogenic effects of treatment settings; from lack of recent opportunities for self-determination; from the negative side effects of unemployment; and from crushed dreams. Recovery is often a complex, time-consuming process.’

His definition was developed further by founder members of Recovery Devon, including Laurie Davidson and Glenn Roberts, into a set of principles and what they mean in practice: ‘Recovery – Concepts and Application’.

The following is an abbreviated version, which was quoted inside the cover of ‘Making Recovery a Reality’, Sainsbury Centre for Mental Health.

The Principles of Recovery

‘Recovery is about building a meaningful and satisfying life, as defined by the person themselves, whether or not there are ongoing or recurring symptoms or problems.

Recovery represents a movement away from pathology, illness and symptoms to health, strengths and wellness.

Hope is central to recovery and can be enhanced by each person seeing how they can have more active control over their lives (‘agency’) and by seeing how others have found a way forward.

Self-management is encouraged and facilitated. The processes of self-management are similar, but what works may be very different for each individual. No ‘one size fits all’.

The helping relationship between clinicians and patients moves away from being expert / patient to being ‘coaches’ or ‘partners’ on a journey of discovery. Clinicians are there to be “on tap, not on top”.

People do not recover in isolation. Recovery is closely associated with social inclusion and being able to take on meaningful and satisfying social roles within local communities, rather than in segregated services.

Recovery is about discovering – or re-discovering – a sense of personal identity, separate from illness or disability.

The language used and the stories and meanings that are constructed have great significance as mediators of the recovery process. These shared meanings either support a sense of hope and possibility, or invite pessimism and chronicity.

The development of recovery-based services emphasises the personal qualities of staff as much as their formal qualifications. It seeks to cultivate their capacity for hope, creativity, care, compassion, realism and resilience.

Family and other supporters are often crucial to recovery and they should be included as partners wherever possible. However, peer support is central for many people in their recovery.’

Laurie also wrote the following valediction, just before retiring in 2009.

laurie“Having started working in mental health in 1968, I have been involved with setting up a range of community mental health services and closing down several institutions all over the UK. Community Care was about the style and delivery of services and played a vital role in emphasising the importance of environment and civil liberties.

Recovery is even more important than de-institutionalisation, because it challenges the way people are treated and the way mental health staff work; it challenges the attitudes and beliefs we hold and it starts to address the historic power imbalances which have been so damaging for so many for so long.

Recovery challenges the established order and as such, is a ‘great idea’ along with the ideas of evolution or a ‘round earth’; turning all our thinking upside down. Recovery challenges everything we ‘knew to be true’.

Recovery shifts our main focus away from ’treatment and cure’ of symptoms towards how people can live well and stay well with or without symptoms.

Recovery challenges the sacred cows of the establishment including questioning the validity and role of diagnosis, the use of involuntary treatment and the legal framework, the books we have read, long held attitudes and assumptions, the ‘truth’ of learned dogma and the medicalisation of social and personal experience. Unlearning becomes as important as learning.

Recovery challenges the settings in which help is provided, informed by the personal stories of what helps or hinders recovery. It questions the current deployment of funds into services and approaches where people say their needs are not being met.

Most of all, recovery challenges the nature of relationships; moving away from ‘parent to child’ towards ‘adult to adult’, away from the disempowering aspects of ‘expertise’ towards the sharing of knowledge and more of a peer relationship; away from designing care plans or risk assessments ‘for’ people towards following individual goals and negotiated safety planning.

Seeing the world through recovery glasses challenges the way staff are trained and treated. Supervision, work management, outcome measurement, job planning, recruitment, training strategies, policies and procedures, support services, governance and incident management all have to be revisited in the light of recovery values.

There is a good reason why all mental health policy in the English speaking world has signed up to recovery. It works as a set of values (not a model) which are based on common sense and respect for individual choice. Recovery ideas will evolve and develop as their revolutionary implications are more fully recognised.

Good luck to Recovery Devon in the future. You are very special people. I will miss you all.”

Recovery Devon Newsletter, Spring 2009, page 16