Recovery is generally seen in this model as a personal journey rather than a set outcome, and one that may involve developing hope, a secure base and sense of self, supportive relationships, empowerment, social inclusion, coping skills, and meaning.
William Anthony,[2] Director of the Boston Centre for Psychiatric Rehabilitation developed a cornerstone definition of mental health recovery in 1993.
A recovery-oriented approach has since been explicitly embraced as the guiding principle of mental health and substance dependency policies in numerous countries and states.
Several standardized measures have been developed to assess different aspects of recovery, although there is some divergence between professionalized models and those originating in the psychiatric survivors movement.
The researchers suggested implementing the intervention among a population with higher baseline values on the need for recovery and providing opportunities for physical activity, such as organizing lunchtime walking or yoga classes at work.
The study concluded that relatively simple environment modifications, such as placing signs to promote stair use, did not lead to changes in the need for recovery.
[10] The professional literature, starting with the psychiatric rehabilitation movement in particular, began to incorporate the concept from the early 1990s in the United States, followed by New Zealand and more recently across nearly all countries within the "First World".
A key issue became how service consumers could maintain the ownership and authenticity of recovery concepts while also supporting them in professional policy and practice.
[23][24] Others who have experienced similar difficulties and are on a journey of recovery can also play a role in establishing community and combating a recovering person's feelings of isolation.
Safe houses aim to support survivors on account of their individual needs and can effectively rehabilitate those recovering from issues such as sexual violence and drug addiction without criminalization.
This can involve making use of medication or psychotherapy if the patient is fully informed and listened to, including about adverse effects and about which methods fit with the consumer's life and their journey of recovery.
[30] Appropriate housing, a sufficient income, freedom from violence, and adequate access to health care have also been proposed[31] as important tools to empowering someone and increasing her/his self-sufficiency.
Women's Empowerment Theory suggests that recovery from mental illness, substance abuse, and trauma requires helping survivors understand their rights so they can increase their capacity to make autonomous choices.
[18][32] This can mean develop the confidence for independent assertive decision making and help-seeking which translates into proper medication and active self care practices.
Advocates of Women's Empowerment Theory argue it is important to recognize that a recovering person's view of self is perpetuated by stereotypes and combating those narratives.
[37] From a psychiatric rehabilitation perspective, a number of additional qualities of the recovery process have been suggested, including that it: can occur without professional intervention, but requires people who believe in and stand by the person in recovery; does not depend on believing certain theories about the cause of conditions; can be said to occur even if symptoms later re-occur, but does change the frequency and duration of symptoms; requires recovery from the consequences of a psychiatric condition as well as the condition itself; is not linear but does tend to take place as a series of small steps; does not mean the person was never really psychiatrically disabled; focuses on wellness not illness, and on consumer choice.
[40] One approach to recovery known as the Tidal Model focuses on the continuous process of change inherent in all people, conveying the meaning of experiences through water metaphors.
For many, recovery has a political as well as personal implication—where to recover is to: find meaning; challenge prejudice (including diagnostic "labels" in some cases); perhaps to be a "bad" non-compliant patient and refuse to accept the indoctrination of the system; to reclaim a chosen life and place within society; and to validate the self.
[42] In general, recovery may be seen as more of a philosophy or attitude than a specific model, requiring fundamentally that "we regain personal power and a valued place in our communities.
While interventions in this area have tended to focus on harm reduction, particularly through substitute prescribing (or alternatively requiring total abstinence) recovery approaches have emphasized the need to simultaneously address the whole of people's lives, and to encourage aspirations while promoting equal access and opportunities within society.
[44] The purpose of this model is to rehabilitate those experiencing addiction in a holistic way rather than through law enforcement and criminal justice-based intervention which can fail to address victims’ circumstances on a need-by-need basis.
Advocates of trauma-informed care argue the principles and strategies should be applied to individuals experiencing mental illness, substance dependence, and trauma as these three often occur simultaneously or as result of each other.
Scholars claim that neglecting the role of trauma in a person's story can interfere with recovery in the form of misdiagnosis, inaccurate treatment, or retraumatization.
[23][21] In addition, these principles can apply to all steps of the recovery process within a service providing context, including outreach and engagement, screening, advocacy, crisis intervention, and resource coordination.
Advocates of trauma-informed care critique traditional service delivery systems, such as standard hospitals, for failing to understand the role of trauma in a patient's life.
[23][47] Specific practices in traditional service delivery systems, such as unnecessary procedures, undressing for examinations, involuntary hospitalizations, crowded emergency rooms, and limited time for providers to meet with patients, have all been critiqued as insensitive to persons recovering from trauma and consequential mental illness or substance abuse.
[48] Other criticisms focused on practical implementation by service providers include that: the recovery model can be manipulated by officials to serve various political and financial interests including withdrawing services and pushing people out before they're ready; that it is becoming a new orthodoxy or bandwagon that neglects the empowerment aspects and structural problems of societies and primarily represents a middle class experience; that it hides the continued dominance of a medical model; and that it potentially increases social exclusion and marginalizes those who don't fit into a recovery narrative.
[54][55][56][57] Some positives and negatives of recovery models were highlighted in a study of a community mental health service for people diagnosed with schizophrenia.
Cultural biases and uncertainties were also noted in the 'North American' model of recovery in practice, reflecting views about the sorts of contributions and lifestyles that should be considered valuable or acceptable.
[79] The Mental Health Commission of Ireland reports that its guiding documents place the service user at the core and emphasize an individual's personal journey towards recovery.