Speaking of recovery… presentation

Speaking of Recovery….
Carole Eaton, BA(Hons), MA, R.Psych, RTC ,CPRP
Executive Director
Phoenix Residential Society
What does it mean?
What does it involve?
What is required to achieve it?
Historical Perspective
Deinstitutionalization –“The Saskatchewan
Plan” beginning in the 60’s
The 1960’s/70 saw the dawn of the
Community Based Model – outpatient
community clinics, approved home system,
CMHA day programs/drop in.
◦ *Phoenix House was the first psychiatric group
home of its kind in Saskatchewan (1977)
The Evidence for Recovery: Research
Studies and Self-Reports
“Methodologically-sound studies have found that
one half to two thirds of over 1300 subjects
studied longer than 20 years achieved recovery
with significant improvement” (Harding et al., 1992)
The evidence is widely supported by the self-help
and consumer/survivor literature.
“We are the evidence!”
(Chris Summerville, Schizophrenia Society of
Historical Perspective
Schizophrenia and other serious psychiatric
disabilities have been viewed as “irreversible
illness” with increasing disability over time.
Mental health program policies and practices have
been developed and implemented to support this
uncompromisingly negative view of the predicted
outcome for people with psychiatric disability.
Harding, C.M., Zubin, J., Strauss., J.S. Chronicity in Schizophrenia:
Revisited. British Journal of Psychiatry, 1992,161,27-37
While the impact of serious mental illness is
devasting to those who experience it and to
their families, it does not appear that serious
mental illness is necessarily a disease of slow
and progressive deterioration as was once
widely believed.
People with serious mental illness can achieve
partial or full recovery from the illness as any
point during its course even in the later stages
of their life.
Reference: (Harding, et al., 1992)
Results of Long-term Studies on Outcomes
in Schizophrenia
Vermont: 32 years, 269 patient, 68% full
recovery or significantly improved (Harding et al.,
Maine: 32 years, subjects matched to Vermont
group, 119 patients, 49% full recovery or
significantly improved (DeSisto, Harding et al,
Lausanne: 37 years, 289 patients, 57% full
recovery or significantly improved (Ciompi &
Muller, 1976)
Iowa: 35 years, 186 patients, 46% full recovery
or significantly improved (Tsuang, et al, 1976)
Zurich: 26 -33 years, 208 patients, 53-66% full
recovery or significantly improved (Bleuler, 1972)
Bonn: 22 years, 502 patients, 53% full recovery
or significantly improved (Huber, 1975)
What is Recovery?
Recovery, as we currently understand it, means growing beyond
the catastrophe of mental illness, and developing new
meaning and purpose in one’s life. It means taking charge of
one’s life even if one cannot take complete charge of one’s
symptoms. Much of the chronicity that is thought to be a
part of people’s mental illness may be due to the way the
mental health system and society treat people with severe
mental illness. Contributing to people’s chronicity are factors
such as stigma, lowered social status, restrictions on choice
and self-determination, the lack or partial lack of
rehabilitation opportunities, and low staff expectations.
Drastic system changes are needed if we wish to support
people’s recovery, rather than hinder people’s recovery.
William Anthony, PhD
What is Recovery?
Recovery is “a deeply personal, unique
process of changing one’s attitudes, values,
feelings, goals, skills and/or roles. It is a
way of living a satisfying, hopeful and
contributing life even with limitations
caused by the illness. Recovery involves
the development of new meaning and
purpose in one’s life.
William Anthony
Recovery is:
“a process in which an individual
confronts challenges using a unique
combination of strengths, vulnerabilities
and available resources”
“…a non-linear process that involves
making progress, losing ground, and
pressing forward again”
In other words…
“ a process of restoring a meaningful sense
of belonging to one’s community and
positive sense of identity apart from ones’
condition while rebuilding a life despite
one’s limitations imposed by that
Davidson, L., Tondora, J. O’Connell, M., Kirk, T., Rockholz, P., and Evans,
A. (2007). Creating a Recovery-Oriented System of Behavioral Health
Care: Moving from Concept to Reality. Psychiatric Rehabilitation
Journal. 31, 23-31.
Recovery can occur without professional
“The task of professionals is to
facilitate recovery; the task of
consumers is to recover”
A common denominator of recovery is
the presence of people who believe in and
stand by the person in need of recovery.
“People who are recovering talk about the
people who believed in them when they
didn’t believe in themselves, who
encouraged their recovery but did not force
it, who tried to listen and understand when
nothing seem to make sense”
A recovery vision is not a function of
one’s theory about the causes of mental
“Whether the causes of mental illness are
viewed as biological and/or
psychosocial…does not commit one to
either position on this debate, nor on the
use or nonuse of medical interventions”
Recovery can occur even though symptoms
“the episodic nature of severe
mental illness does not prevent
Recovery changes the frequency and
duration of symptoms.
“as one recovers, the symptom
frequency and duration appear to
have been changed for the better;
interfere with functioning less often
and for briefer periods; and return to
previous function occurs more
Recovery does not feel like a linear process.
“recovery involves growth,
setbacks, periods of rapid change,
and little change and across
different areas of functioning”
Recovery from the consequences of the
illness is sometimes more difficult than
recovering from the illness itself.
“disabilities, disadvantages and barriers
brought on by being placed in the category
of mentally ill can limit a person’s recovery
even though one has become
predominately asymptomatic”
Recovery from mental illness does not
mean that one was not mentally ill.
“at times people who have successfully recovered
from severe mental illness have been seen as an
aberration or a fraud, rather than their successful
recovery being seen as a model or a beacon of
hope” for others.
Recovery from Mental Illness: The Guiding Vision of the Mental Health Service System in the 1990’s
Psychosocial Rehabilitation Journal, 1993, 16(4), 11-13
The ‘Davidison’ Distinction
Recovery from serious mental illness
◦ Involves the amelioration of symptoms and the person’s
returning to a healthy state following onset of the illness
◦ Recovery from the psychosis, same as recovering from a broken
Recovery in serious mental illness
◦ Treatment has limited success and existing care is relativity
◦ Recovery in means accepting that for the near future the
condition will not go away so focus must include learning how to
live with it
Davidson and Roe (2007). Recovery from versus recovery in serious
mental illness: One strategy for lessen confusion plaguing recovery.
Journal of Mental Health, 16, 459-470
Substance Abuse and Mental Health Services
Administration (SAMHSA)
10 fundamental components of recovery
 Hope
 Medication/Treatment
 Empowerment
 Support
 Education/Knowledge
 Self-Help
 Spirituality
 Employment/Meaningful Activities
“How do you link the abstract concepts that
define recovery with specific strategies that
systems, agencies, and individuals use to
facilitate it”?
External conditions include:
◦ human rights
◦ a positive culture of healing
◦ recovery – oriented services
What is Recovery? A Conceptual Model and Explination
Jacobson, N., 2001
External Conditions
Human Rights
oReducing stigma
o Protecting the rights of the individual (i.e.
shared decision making)-(Patricia Deegan)
o Equal opportunities for education,
employment, housing
o Access to resources
o food and shelter (income security)
o social and health services (as long as needed)
A “coherent social faith”
with a culture of inclusion,
hope, humor, dignity, respect
and love”
Providers must embrace the
belief that EVERY person can
achieve hope, healing,
empowerment and
connection, regardless of
current status
Human services
environment characterized
by tolerance, empathy,
compassion, respect, safety,
Relationships defined by
collaboration with active
participation and a wide
range of options offered,
including some with risk
External Conditions
Symptom Relief
Life Enrichment
Basic Support
What Would A Recovery-Oriented System
Look Like?
Symptom Relief
Crisis Intervention
Personal Safety
Case Management
Services accessed
Role functioning
Rights Protected
Equal opportunity
Basic Support (housing)
Personal Survival
Health Status Improved
Anthony, 2000
What can help us get there?
Recovery oriented Psychosocial (Psychiatric)
Psychosocial (Psychiatric) Rehabilitation is a
field, an approach, and a service to people with
serious psychiatric difficulties.
Psychosocial (Psychiatric) Rehabilitation
interventions are specific strategies to assist a
person to acquire the necessary skills,
behaviours, and resources that will lead them to
What do people with lived experience say helps?
Being supported by Others
Renewing Hope and Commitment
Engaging in Meaningful Activities
Redefining Self
Incorporating Illness
Overcoming Stigma
Assuming Control
Managing Symptoms
Becoming Empowered and Exercising Citizenship
Davidson, L., Tondora, J. O’Connell, M., Kirk, T., Rockholz, P., and Evans, A. (2007).
Creating a Recovery – Oriented System of Behavioral Health Care; Moving from
Concept to Reality. Psychiatric Rehabilitation Journal, 31, 23-31
Recovery Oriented System
Their Core Values – Conneticut Experience
Recovery encompasses all phases of care
People have imput at every level
Use “recovery-based” outcome measures
Consumers review funding
Commitment to peer support and consumer operated services
Participation on boards, committees and other decision – making
Staff must know all resources and treatment options
Individually tailed services – accessible (“no wrong door”)
Person centred – self-determination ethic
* Kirk, T.A., Evans, AC., Daily, W.F., Implementing a Statewide Recovery –
Oriented System of Care: From Concept to Reality, NASMHPD Research
Institute, 2005
Why Change and Why Recovery?
Provides Hope for us all
Because the evidence is simple not there that
Schizophrenia and other serious mental illness is
necessarily a progressive and chronic illness
We are all recovering (or will) from something
 Because we can learn from people with lived experience
of mental illness;
 Because we can learn from other mental health systems
experience. They can provide “maps” that they have
used to help us move forward.
 Because this will help us in our treatment and service
Because the time has come to develop our own vision
of a recovery-oriented mental health system.

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