The Recovery Orientation

Recovery is a multidimensional concept that complements “traditional” views about outcomes following the onset of a psychotic disorder. The recovery orientation has been adopted within many mental health programs. Staff training and policy development have assisted the shift to this new consumer-created way of thinking.

This recovery philosophy or recovery orientation argues that, with the right environment and supports, people who have experienced a psychotic disorder are able to recover.

Recovery has been defined as “a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills, and/or roles” and “a way of living a satisfying, hopeful, and contributing life even within the limitations caused by illness.”

This concept of recovery does not simply equal the reduction of symptoms and the re-attainment of a prior level of academic or vocational status.  Instead it emphasizes that all persons, regardless of their level of ongoing symptoms can lead meaningful and self-fulfilling lives. It has been argued that it is a recovery of the sense of self that should be the goal of mental health services.

Slade (2009) argues that the recovery orientation’s emphases on agency, empowerment, strengths and purpose are quite different than the clinical training of professions that typically focuses on deficit, psychopathology, dysfunction and risk. This divergence can make it challenging for clinicians to incorporate recovery concepts into daily work.

Slade’s Personal Recovery Framework proposes four recovery-associated tasks:

  1. Developing positive identity beyond illness
  2. Developing meaning to frame the experiences associated with illness
  3. Taking responsibility including self-management
  4. Reassuming valued social roles

The four tasks can be supported by mental health services to support recovery through:  fostering relationships, promoting well-being, offering treatments and education on how to manage psychosis, and improving social inclusion.

Early Psychosis Intervention (EPI) programs and the recovery model

Early identification and intervention programs seek to treat psychosis, and support young persons by facilitating recovery, independence, self-efficacy and the meaningful participation in social, educational and vocational pursuits. Further, EPI seeks to maximize the engagement of clients in programs, minimize the possbility of relapse and to reduce the negative effects of other mental health issues that may also be present, while maximizing recovery.

One important origin of the early psychosis movement concerned the observation that young persons are often traumatized by the onset of a psychotic disorder. This has led to the incorporation of a trauma –based approach to helping young people with psychosis.  In addition to the goal of stopping a psychotic disorder from getting worse, EPI programs have focused upon elements of the recovery process that exceeded most mainstream mental health services.  As such, EPI became a vehicle for system reforms such as:

  • developing age and stage appropriate treatments that put the needs of clients ahead of legal or bureaucratic requirements,
  • placing greater emphasis on including the family and paying attention to social contexts,
  • emphasizing the importance of engagement in treatment by using minimal doses of medications,
  • promoting self-management and
  • the explicit use of clinicians to assist with the psychological, social and environmental elements of recovery.

Further, the EPI model emphasizes hope as a central message to convey to clients/families and professionals as it is one of the most important element necessary for recovery to occur.

Several vital features have set EPI services apart from standard mental health teams. The key features of such programs include:

  • Acceptability for young people
  • Accessibility / reduced waiting time for assessment
  • Non-stigmatizing approaches in all program components
  • Collaborative treatment planning
  • Holistic approach committed to improving functional, social, symptomatic and vocational outcomes
  • Willingness to initiate early, appropriate treatment including the assertive early identification and treatment of refractory cases
  • Engagement with and involvement of careers/significant others
  • Addresses the specific needs of people with first episode psychosis
  • Assertive vocational rehabilitation

Thus, many of these facets of EPI-related work are consistent with the goals of the emerging consumer-defined recovery orientation. EPI services strive to use the most effective ways they can to support people achieve the best lives possible.  Simply focusing on symptoms is not good enough.

Slade, M. (2009) The contribution of mental health services to recovery.  Journal of Mental Health, 18(5): 367-371.