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For a long time it was thought that people diagnosed with a mental illness never recovered that they would need to be cared for and would never live a meaningful life. However there has emerged a much more positive outlook for many people. This has come about through the publication of personal stories and through looking at long term research which shows that even people that have been seriously affected by mental illness can and do recover. This means people live independently, have meaningful social relationships and work and live a satisfying, contributing life even if there remains some limitations caused by the illness.
The evidence
The ‘recipe’
Assisting recovery
The ‘Recipe’
Despite there being no simple formula for recovery there are some common themes that have emerged. They involve the interplay between internal conditions(the person’s attitudes, experiences, sense of hope an sense of meaning or purpose) and external conditions both social and physical (relationships for comfort and intimacy, peer support, good food, a decent place to live, meaningful activities, work and services).
Hope
Hope lays the groundwork for recovery. It is the person’s belief that recovery is possible. It involves recognising and accepting that there is a problem, committing to change, focusing on strengths rather than ruminating on the past, celebrating small successes rather that expecting rapid change, reordering priorities and cultivating optimism. Hope expands the sphere of possibility and sustains people even during periods of relapse.
As discussed earlier, people who develop a psychosis are subject to believing the common negative stereotypes and stigma around mental illness. They can then internalise these when they become ill, leading to a destruction of self esteem and identity, making personal growth, risk taking and recovery difficult. This negativity can be reinforced by mental health professionals, family, friends and the community. It can therefore be seen that it is very important for people who have become unwell to have people around them who maintain hope and a belief that recovery is possible.
Finding a sense of one’s self and a sense of control.
Recovery involves finding the self apart from the illness - realizing they are not the illness, only that they have an illness. The illness is not who they are. As this reconnection with themselves occur, self-esteem and self respect can again emerge. This can lead to a sense of control and a sense of purpose. A sense of control can come from managing the illness. This may involve medication, developing a healthy lifestyle, monitoring stress and early warning signs and using the necessary strategies to manage these. Control also comes from the belief by the person that they can control their own lives; that they are masters of their own destiny. The sense of purpose can develop through relationships, work, political action, creativity or spirituality. Carers can encourage these activities.
Empowerment People involved in the mental health service system can develop a sense of helplessness, dependency and lack of control. They go through hospital wards, are placed on Treatment Orders and those around them consistently tell them what to do and give negative messages about their future.
However, when a person’s identity shifts from being a patient to being a person who has control, then a sense of empowerment emerges. This has three components.
If you are a family member or carer working within the recovery framework you would allow the person you care for to set their own goals and allow them the opportunity to fail and learn from mistakes. As caring people we naturally don’t want the people we love or care for to make mistakes. We want to protect people from the stress that this may cause.
However, in order for recovery to take place people need to gradually assume more responsibility for themselves. This involves developing goals, working with family, friends and professionals to reach the goals, making decisions and taking care of themselves. Full empowerment means people living with the consequences of their choices.
Connection
Recovery is a profoundly social process that involves reconnecting with others and the world-“getting a life”. To make connections, social roles need to be established. These may be through activities, relationships or work.
Studies have shown that people with a mental illness have social relationships roughly half the size of the general population. Further, limited social supports increase the likelihood of symptoms and reduce the likelihood of supports being accessed in times of stress. Many people have found that one of the most powerful forms of connection is through helping others with a mental illness, by becoming an advocate, a mental health service provider, joining a self help group or telling their own stories. In this way they can validate and reconcile their own experience and serve as a role model for others.
Human rights
The conditions in the society in which a person lives can affect a person’s ability to recover. Negative portrayals of people with mental illness, often in the media, can lead to stigma and discrimination. People with mental illness deserve all their basic human rights available to them. These include inclusion in education, employment and housing as well as the full range of social and health services. Without these the availability of choices is restricted.
Assisting recovery
People who are recovering have described specific ways others have helped them.
These include:
Ventilation: being able to converse with others; share concerns.
Reality testing: having people assist in maintaining clear distinctions between reality and psychotic distortions
Material support: helping with financial, housing and transportation problems
Social approval and integration: receiving reassurance when people accept them and provide a sense of belonging
Constancy: associating with people they knew before hospitalization, connecting current identity with pre – hospital identity and giving roots to existence
Motivation: receiving encouragement to achieve higher levels of occupational and social functioning
Modelling: observing the behaviour of others and incorporating it into their own behaviour
Symptom monitoring: having others alert them to manifestations of symptoms
Problem solving: discussing problems and getting concrete feedback
Empathic understanding: being understood by people important to them
Reciprocal relating: becoming an equal partner, able to share and be of assistance to others
Insight: acquiring more complete and accurate understanding of themselves.
Overall carers can help a person recover by encouraging hope, trusting the person, accepting them as they are, providing options, encouraging a healthy lifestyle, focusing on strengths, allowing risks and consequences.
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