This document provides an overview of the concept of recovery in mental health. It discusses the history and origins of recovery as defined by service user activists, outlines various definitions of recovery including clinical and personal perspectives, and reviews frameworks that have been developed to describe the recovery process. The document also examines issues with quantifying recovery and potential abuses of the recovery model. It argues that social work approaches to recovery should focus on both personal change and challenging oppressive social structures. Finally, it suggests moving towards a social justice definition of recovery that promotes social inclusion, combats stigma, and creates supportive environments.

1. Recovery in
Mental Health
AGNES BEZZINA
TEACHING FELLOW – SOCIAL WORK
UNIVERSITY OF BRISTOL
08.02.2016

2. Session Plan
 INTRO: What does recovery look like to you?
 What recovery looks like to me …
 A history of recovery in mental health
 The Social Construction of Recovery
 Definitions …
 The Clinical vs The Personal
 Frameworks and Stars – Quantifying Recovery?
 Abuses of Recovery
 Ten Top Tips to Recovery-Oriented Practice
 Recovery and Social Work
 Towards a Social Justice Definition of Recovery

3. What does recovery look like to you?

4. What recovery looks like to me at present …
An integrated identity …

5. A history of recovery …
The story of John Thomas Perceval (1803 – 1876) …
Detained in
‘mental asylums’
for a number of
years, including
Brislington House
in Bristol

6. A history of recovery …
Perceval speaks of his
‘recovery’, attributing
this to various factors,
including:
• access to books he
enjoyed reading;
• contact with family;
• spirituality;
• acceptance by
others; and
• being a voice for
others.

7. A history of recovery …
(Bateson, 1961, p.xiii)
Perceval turned his rage into action, and the same action proved
fundamental to his recovery. He has been acknowledged as a mental
health advocacy pioneer for his lifetime campaign. (Brandon, 2007)

8. A history of recovery …
 The initial impetus for the development of ‘recovery’ in
mental health came from the ‘survivor’ movement, most
particularly within the United States during the late 1980s
and early 1990s (Roberts & Wolfson, 2004).
 Publishing of a number of first-person accounts of
‘recovery’ from mental illness:
 Marcia Lovejoy (1984): Recovery From Schizophrenia: A
Personal Odyssey
 Esso Leete (1989): How I Perceive and Manage my Illness
 Ron Coleman (1999): Recovery: An Alien Concept

9. ‘Recovery’ integrated into policy
 The journey to recovery: the Government’s vision for mental
health care (2001):
 “The mental health system must support people in settings of their
own choosing, enable access to community resources including
housing, education, work, friendships – or whatever they think is
critical to their own recovery” (p.24)
 No health without mental health (2011):
 “Objective (ii) – More people with mental health problems will
recover:
More people who develop mental health problems will have a good
quality of life – greater ability to manage their own lives, stronger
social relationships, a greater sense of purpose, the skills they need
for living and working, improved chances in education, better
employment rates, and a suitable and stable place to live.” (p.30)

10. The Social Construction of Recovery
 Countless definitions of ‘recovery’:
“Each definition uses its own language and fits
different disciplines, models or frameworks…there
are unlimited definitions and meanings of
recovery, none of which are right or wrong…”
(Campbell et.al, 2013, p.39)
 YET, from a Foucauldian perspective, power
relations in society are expressed through
language use – or discourse
 Therefore, the definition we adopt represents a
particular discourse, a particular way of thought,
and we need to reflect on the role of power within
this discourse.

11. Some definitions …
CLINICAL Recovery …
Full symptom remission, full or
part time work / education,
independent living without
supervision by informal carers,
having friends with whom
activities can be shared –
sustained or a period of 2 years
(Lieberman and Kopelowicz, 2002)

12. Some definitions …
“The goal of recovery is not to become
normal. The goal is to embrace the human
vocation of becoming more deeply, more
fully human.”
(Pat Deegan, 1996)
“Recovery is not a gift from clinicians, but the responsibility of us all. We
must become confident in our own ability to change our lives, we must
give up being reliant on others doing everything for us. We must have
the confidence to give up being ill so that we can start being recovered.”
(Ron Coleman, 1999)
PERSONAL Recovery …
http://www.mentalhealthcare.o
rg.uk/view_all_videos/mike_sla
de_video_clip_1

13. The Clinical vs The Personal …
• “Flat. Lacking in motivation, sleep and appetite good. Discussed
aetiology. Cont. LiCarb 250mg qid. Levels next time.”
EXTRACT
FROM
CLINICAL
NOTES
• “Today I wanted to die. Everything was hurting. My body was
screaming. I saw the doctor. I said nothing. Now I feel terrible.
Nothing seems good and nothing good seems possible. I am
stuck in this twilight mood where I go down into a lonely black
hole. Where there is room for only one.”
EXTRACT
FROM DIARY
(O’Hagan, 1996)

14. The CHIME Framework
Connectedness
Hope and optimism
Identity
Meaning and purpose
Empowerment
(Leamy, Bird, Le Boutillier, Williams and Slade, 2011)

15. The Recovery Outcomes Star …

16. Quantifying recovery??
 ‘Processes’ vs ‘outcomes’
 Is the primary loyalty to:
 “the application of a rather reductionist form of science” OR
 “the honouring of lived experience and to justice in service systems and the
wider society” (O’Hagan, 2012a)
 “…lack of standardisation in data collection” (Dickens et.al, 2012)
 Conceptualising recovery as a ‘model’
 “…may fit with the constructs and understanding of practitioners” BUT
 “could destroy the essence of recovery from the service-user discourse drawn
from lived experience”
(Campbell et.al 2012, p.39)
 There is a sense of ‘recovery’ being hijacked by professionals (O’Hagan,
2012b)

17. ABUSES of Recovery …
1. Recovery is the latest model;
2. Recovery does not apply to “my” patients;
3. Services can make people recover through effective
treatment;
4. Compulsory detention and treatment aid recovery;
5. A recovery orientation means closing services;
6. Recovery is about making people independent and
normal;
7. Contributing to society happens only after the person
has recovered.
(Slade et.al, 2014)

18. Recovery and Social Work …
 The central tenets of the recovery movement are supported by social
work values, most notably those of:
 consumer empowerment
 self-determination
 worth of the individual, and
 concern for the environmental role in personal experience
(Carpenter, 2002)
 For social work, ‘recovery’ should not be just about facilitating personal
change, but also about generating change in the oppressive structures
that are hindering recovery:
“…finding ways in which service users, family, friends and practitioners
can work collaboratively both to challenge and to resist the corrosive
impact of social oppression.”
(Tew et.al 2012, p.455)

19. Towards a social justice
definition of recovery …
 “…facilitating social justice for persons in recovery means
directly targeting the injustices and discrimination that they
experiences due to stigma” (Carr et.al 2014, p.1112)
“
“…recovery-oriented social work
interventions should be directed at
promoting social citizenship for people
diagnosed with mental illness,
combating stigma, and creating the
psychological and social environments
for finding meaning and hope after
receiving a diagnosis.”
(Williams, Almeida, & Knyahnytska, 2015)

20. Recovery is …
‘Recovery’ is the term that mental health service user activists
adopted as a political statement to spotlight the totality of their
being, away from professionals’ definition of maintaining a
symptom-free existence, to one in which they live life in its
entirety, in the way they choose, while establishing their own
strategies to manage their mental health.
It is also the word that some mental health service user activists
are now considering abandoning as they believe that this has
been ‘colonised’ by professionals, and integrated into policy in a
way that makes it unrecognisable to them, as it has been reduced
to measureable outcomes debasing their personal, individual
journey as a process.

21. References
 Bateson, G. (1961). Perceval’s Narrative: A Patient’s Account of his
Psychosis 1830-1832. Stanford: Stanford University Press.
 Brandon, D. (2007, October). A friend to alleged lunatics. Mental Health
Today: 37-39.
 Campbell, J., Stickley, T. Bonney, S. and Wright, N. (2012). Recovery as a
framework for care planning. In A. Hall, M. Wren and S.D. Kirby (Eds.) Care
Planning in Mental Health: Promoting Recovery. Oxford: Wiley Blackwell.
 Carpenter, J. (2002). Mental health recovery paradigm: implications for
social work. Health and Social Work, 27(2): 86-94.
 Carr, E.R., Bhagwat, R., Miller, R. and Ponce, A.N. (2014). Training in mental
health recovery and social justice in the public sector. The Counselling
Psychologist, 42(8): 1108-1135.
 Coleman, R. (1999). Recovery: An Alien Concept. Gloucester: Handsell
Publishing.

22.  Deegan, P. (1996). Recovery as a journey of the heart. Psychiatric
Rehabilitation Journal, 19(3): 91-97.
 Department of Health (2001). The Journey to Recovery: The Government’s
Vision for Mental Health Care. London: DOH.
 Dickens, G., Weleminsky, J., Onifade, Y. and Sugarman, P. (2012). Recovery
Star: validating user recovery. The Psychiatrist Online, 36: 45-50.
 HM G. (2011). No Health Without Mental Health: Developing Better
Mental Health Outcomes for People of all Ages. London: Department of
Health
 Leamy, M., Bird, V., Le Boutillier, C., Williams, J. and Slade M. (2011)
Conceptual framework for personal recovery in mental health: systematic
review and narrative synthesis. The British Journal of Psychiatry, 199(6):
445-452.
 Leete, E. (1989). How I perceive and manage my illness. Schizophrenia
Bulletin, 15(2): 197-200.
 Lovejoy, M. (1984). Recovery from schizophrenia: a personal odyssey.
Psychiatric Services, 35(8): 809-812.

23.  O’Hagan, M. (1996). Two accounts of mental distress. In J. Read and J.
Reynolds (Eds), Speaking Our Mind. London: Macmillan.
 O’Hagan, M. (2012a). Recovery: is consensus possible? World Psychiatry, 11(3):
167-168.
 O’Hagan, M. (2012b). The science of recovery. Retrieved from:
http://www.scottishrecovery.net/Latest-News/the-science-of-recovery.html
 Roberts, G. and Wolfson, P. (2004). The rediscovery of recovery: open to all.
Advances in Psychiatric Treatment, 10(1): 37–49.
 Slade, M., Amering, M., Farkas, M., Hamilton, B., O’Hagan, M., Panther, G.,
Perkins, R., Shepherd, G., Tse, S., and Whitley, R. (2014). Uses and abuses of
recovery: implementing recovery-oriented practices in mental health systems.
World Psychiatry, 13(1): 12-20.
 Tew, J., Ramon, S., Slade, M., Bird, V., Melton, J. and Le Boutillier, C. (2012).
Social factors and recovery from mental health difficulties: a review of the
evidence. British Journal of Social Work, 42(3): 443-460.
 Williams, C.C., Almeida, M. and Knyahnytska, Y. (2015). Towards a
Biopsychosociopolitical frame for recovery in the context of mental illness.
British Journal of Social Work, 45, Supplement 1, i9–i26.