The question of ‘how can mental health workers incorporate the principles of recovery based care into everyday practice?’ is one that has confronted us since the closure of the asylums. In 1993 Willam Anthony linked the concept of mental health recovery to that of physical illness and disability, arguing that recovery, “is a way of living a satisfying, hopeful, and contributing life even with limitations caused by illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness.”
This has continued to provide a broad-based definition of recovery, one that is endorsed by policy makers across the United Kingdom as well as internationally. The core concepts associated with recovery are the growth of Hope, Agency and Opportunity. In Scotland, the Scottish Recovery Network identify recovery as being a personal journey, a goal for some and a destination for others, with a focus on what the individual can do as opposed to what they cannot do. This concept of ‘being able to live a good life regardless of symptoms or diagnosis’ is one that informs much of contemporary mental health policy and legislation, and yet is one that is also widely misunderstood.
For many mental health workers ‘recovery’ remains a concept of cure, or ‘recovery from’, rather than recovery in the context of living with a condition. It has been argued that although recovery has become a dominant policy-directed model of many mental health care organizations, many mental health workers do not have a clear description of how to be recovery oriented.
Indeed models of mental illness that exclude a recovery concept remain the dominant models in clinical practice. The unfortunate reality is that many people’s experience of engaging with mental health services remains one of being within a cycle of surveillance and maintenance where one is a recipient, or consumer, of services rather than being the expert by experience. Much of the psychiatric literature reflects recovery as a prolonged absence of symptomatology or ‘psychiatric rehabilitation’.
While recovery is about the individual and their ability to have control and agency in their own life, clearly health and social care mental health services should maximise the individual’s potential to achieve this, and not detract from that potential. Sadly many services, while saying they support a recovery model still practice in a deficit orientated approach, focusing on what is perceived to be ‘wrong’ with the individual and failing to engage with the person’s strengths, abilities and positive life experience.
This can result in services attempting to respond to the unique experience of the individual with a standardised response, in the name of evidence-based-practice. While the principles of recovery are widely accepted by policy makers and legislators, the practical integration of those principles into mental health care is not always evident; for many mental health workers and services, how to deliver recovery-based care remains unclear.
Having posed the question, ‘how can mental health workers incorporate the principles of recovery based care into every day practice?’ we drew upon our background in solution focused interactions to develop an answer. We recognised that solution focused interactions (SFI) help to promote the core concepts of hope, agency and opportunity that are central to mental health recovery. SFI is an umbrella term for those techniques and ways of communicating that grew out of Solution Focused Brief Therapy, developed by Steve De Shazer and Insoo Kim Berg (and colleagues) in the 1980’s. The key principles underpinning SFI focus on the patient’s strengths and abilities rather than on deficits and disabilities; in other words, it focuses on the person as more than their problems and as a result provides the opportunity to foster a sense of hope and agency for patients and clients. Therefore, we believe that providing care that incorporates solution focused conversations will have the effect of promoting recovery-based care in practice.
Steve Smith & Graham Buchanan