Psychosocial recovery

Psychosocial recovery, or the Recovery Model, refers to the process of recovery from mental disorder or substance dependence, and/or from being labeled in those terms. Recovery has been defined as "an individual’s journey of healing and transformation to live a meaningful life in a community of his or her choice while striving to achieve maximum human potential” (U.S. Department of Health and Human Services, 2005). It incorporates a philosophy of support, respect, empowerment, choice, hope, and social inclusion. Originating in programs to overcome substance dependency, the concept of recovery in mental health usage emerged from deinstitutionalization resulting in more individuals living in community settings but there being a perceived failure to support full recovery or enable proper integration into the community in a meaningful manner. The recovery model is a form of social model of disability by contrast to a medical model of disability and may involve "consumers" and "survivors" of mental health service as well as mental health professionals.

History
In general medicine or psychiatry, recovery has long been used to refer to the end of a particular experience of illness. In the context of long-term conditions, it might refer to a period of remission and therefore potentially relapse.

The concept of full 'recovery' as a general philosophy was first popularised in relation to substance use programs, including 12-step approaches.

Application of full recovery concepts to psychiatric disorders is comparatively recent and stems largely from two interrelated sources: the consumer/survivor movement, a grassroots self-help and advocacy initiative, and psychiatric rehabilitation, a professional approach to mental health services provision.

The concept of full recovery has emerged as a significant paradigm in the field of mental health and became increasingly implemented in the policies and practices of mental health systems.

Approaches to recovery
For many, “recovery” has a political as well as personal implication, where to recover is to find meaning, to challenge prejudice, to reclaim a chosen life and place within society, to validate the self. Recovery can thus be viewed as one manifestation of empowerment. Recovery is an individual expierince of the consumer; it is a fundamental change in the consumers concept of self. It is important to recognise that an important feature of recovery from mental illness is that a consumer must be open to failure, disappointment and possible relaspe; that having a realistic allowance for such allows for a greater potential for a successful progress in the reduction of symptoms. [3]

In psychiatric rehabilitation terms, by contrast, recovery refers in large part to functional criteria and reduction of psychosocial disability. To recover is to improve and maintain personal capacity in one or more of the major domains of life, whether it be work, housing, relationships, or recreation.

Evidence and Policy
The psychosocial recovery model has been supported by evidence from both quantitative and qualitative research. Long term (longitudinal) studies have shown that a psychiatric disorder does not necessarily take a course of inevitable deterioration and that, for a significant number of people, a return to full potential is possible. Other research, including studies of reports by consumers/survivors of mental health services, has identified resilience and resourcefullness, diverse and individual pathways of healing, and factors which can enhance or detract from recovery. Increasingly, recovery has become both a subject of mental health services research and a term that is emblematic of many of the goals of the consumer/survivor movement. Specific policy and clinical strategies are currently being used to implement recovery principles although key questions remain.

Attempts are being made by some people and organizations to transform the mental health system to a recovery-based one, with expanded choices of recovery-based services and supports. This is occurring in the United States through plans by the US Department of Health and Human Sciences to develop a National Recovery Initiative (NRI) and State Recovery Initiatives (SRI) involving a shift to consumer-centred or consumer-led planning, with financing mechanisms that support increased consumer control, and creating roles for consumers in service delivery and support. Specific subcommittees are planned to: launch a nationwide pro-recovery, anti-stigma education campaign; develop and synthesize model recovery policies as well as materials for training consumers in board participation; develop materials and train consumers in carrying out evaluations of the performance of mental health systems; supply networking and technical assistance to help further the development of peer-run services