Presentation by Michael Sheehan, from Relationships Australia WA - Whose recovery is it anyway? The risk of imposing our notions of what recovery "should" be in recovery-focused mental health services. Presented at the Western Australian Mental Health Conference 2019.

1. Michael Sheehan
1
Whose recovery is it anyway? The risk of
imposing our notions of what recovery
“should” be in recovery-focused mental
health services

2. Recovery
• The language of “recovery” is a common aspect
in mental health policy & practice
• “Personal and unique process” involving "the
development of new meaning and purpose in
one's life… beyond the impact of mental illness"
(Anthony, 1993, p.527).
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3. Recovery
• A key prerequisite - cultivation of hope &
optimism for the future
• Hope is the trigger of the recovery process &
maintaining factor

4. Hope
• Services have a duty to provide atmosphere
of hope & optimism
• Mental health practitioners have a key role in
“carrying hope” for service users (of recovery)

5. Mental Health
Commission
• 2020 Strategic Policy - ten year plan
• “Making it personal & everybody's business”
• Reforming WA’s mental health system & setting
priority areas for action

6. 2020 Strategic Policy
• “Recovery” x 40
• “Hope” x 2
• “Person-centred” x 23
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7. Hope-inspiring
factors
• Absence of any understanding of the conditions
for hope to flourish either within services or
within the professional
• No mention of the hope-inspiring practices
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8. Hope-inspiring factors
• No mention of the interpersonal practices that
would facilitate recovery & hope:
• compassion
• empathy
• therapeutic
• nurturing
• trust
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9. Recovery concept
• Idealistic- little meaning and impact on people’s
lives
• Involves the imposition of our preconceived
ideas - source of intolerance and oppression for
those who do not fit our expectations

10. People’s
experiences
• Evidenced through service users' own experiences of
cold & uncaring responses/environments
• Gatekeeping or changing the person so they ‘fit in’
• More focused on risk & surveillance
(Psychiatric Services On Line Information System - PSOLIS)
• Workers report frustration about inability to provide the
kind of care & support they had hoped to deliver
(Koekkoek et al., 2009).

11. Preconceived definitions
• Recovery = symptom-free, socially included &
independent (Spandler, 2007)
• Individuals requiring ongoing care demonised as
“dependent” or “recovery resistant” (Hoggett, 2000)
• Distress & frustration seen as potential violence
• If they don’t agree with the perspectives of the
‘experts’ they lack ‘insight’ or are ‘non-compliant’

12. John
The selection panel met today and carefully
considered your referral. Unfortunately this has been
declined on the basis of the following:
• Concerns regarding John’s OCD issues and
shared bathroom/toilets and communal areas
• Unwilling to discuss goals/aspirations for the future
- which is a key feature of our recovery program
• Alerts relating to safety of staff
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13. John’s view
• John has unmet attachment needs and
unresolved trauma from early life and tries to get
his needs met through psychiatric services, but is
unable as services are not set up to support him.
Services haven't made any progress over the
years and remain inflexible. Staff are non-
compliant and want him to ‘fit in’. They also lack
insight into his past experiences and what his
needs are. In the end, John’s earlier experiences
of neglect and rejection are just repeated.
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14. Recovery
• If talk of “recovery” is to have any
effect on people's actual experience
of mental health services, then there
needs to be more than idealistic or
rhetorical language (Spandler & Stickley, 2011)
• Mechanisms – interpersonal
practices/environments
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15. Compassion
• Compassion is necessary to stimulate hope-inspiring
practices & environments
• Sense of purpose, meaning and hope
• Is at the centre of what is to be human – shared
humanity
• Central to mental health recovery

16. Compassion
• Sensitivity to suffering - able to be moved by,
tolerate & understand distress
• Willingness to act to relieve suffering

17. Compassion
• Understanding
• Acceptance
• Tolerance for distress alongside warmth &
kindness
• Understating of a person's unique being in the
world
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18. Shared Humanity
– ‘Symptoms’ of hearing voices (withdrawal, agitation) -
understandable responses not psychopathology
– Self-harm – overwork, alcohol, overeating as response to stress
– Suicidal feelings – legitimate & authentic
– Everyone experiences the challenge of recovery at some point in life
– Anger - a normal, healthy response to violation of one’s integrity;
temporary inversion of power due to imbalance of power (Foucault,
1977)

19. Anger
• that follows in the footsteps of despair
• at the illness which has so devastated us
• at the helping system that may have failed
• at society and its attitudes
• at God for not taking better care of us
• at parents and friends for not being more helpful
• at our self for not being able to manage
• is a necessary and important part of the process
• is a stimulus to recovery
• It is normal and natural. (Spaniol & Koehler, 1994)
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20. Predictors of aggression
• Rigid rules
• Lack of privacy or boundary violations
• Lack of autonomy (locked doors, restraints)
• Strict hierarchy of authority
• Lack of control over the treatment plan
• Denial of requests or privileges
• Lack of meaningful and predictable activities
• Insufficient help with activities of daily living and other
needs
• Patronizing behaviour of staff
• Power struggles related to medications
• Failure of staff to listen, convey empathy
(Hamrin, Iennaco, & Olsen, 2009).
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21. Myths of Recovery
• Everyone’s recovery is different and deeply
personal. There are no rules or formula for ‘success’
• Not an end-product, result, outcome - but a
continuing journey
• Not linear: small beginnings and steps, erratic, slide
back, re-group and start again (Pat Deegan)
• Relapse is not failure, but part of a recovery process
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22. Compassion
• Compassion - not another quick fix, technical
solution, substitute for new therapeutic
strategy/system of care
• A quality underpinning all innovations, policies
and practices

23. Compassion:
• The fostering of hope, the key to recovery,
requires compassionate relationships & contexts
to be meaningful & effective
• Compassionate acceptance - space for people
experiencing mental distress to develop their own
unique ways of accepting & living with (recovering
from) their mental health difficulties

24. Conclusion
Without compassion, the notion of recovery will:
– Have little meaning and impact on people’s lives
– Be a source of intolerance and oppression towards
those who do not fit our expectations of what it should
be
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