Recovery from a psychotic condition is a multidimensional concept and 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 recovery orientation or philosophy argues that, with the right environment and supports, people who have experienced a psychotic disorder can recover.
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 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 emphasis on agency, empowerment, strengths, and purpose is quite different than the traditional clinical training of professions that typically focused on deficit, psychopathology, dysfunction, and risk. This divergence has required a challenging shift for some clinicians to incorporate recovery concepts into their daily work. To date, mental health education programs and mental health programs are now adopting the recovery orientation. Staff training, policy development and practice guidelines have assisted the shift to this new consumer-created way of thinking.
Slade’s Personal Recovery Framework proposes four recovery-associated tasks:
- Developing positive identity beyond illness
- Developing meaning to frame the experiences associated with illness
- Self-efficacy, belief that one’s actions can be effective
- Resuming valued social roles
EPI service providers can support these 4 tasks by applying the best practices as indicated in the EPI Provincials Standards and Guidelines.
Early Psychosis Intervention (EPI) Programs and the Recovery Model
Early identification and intervention programs aim to treat psychosis and support young persons by facilitating recovery from the start. Independence and meaningful participation in social, educational and vocational pursuits are built into the recovery plans together with the individual (and their family/caregivers). The goals for EPI programs include engagement of clients in programs, minimize the possibility of relapse and reduce the negative effects of other mental health issues that may also be present, while maximizing recovery.
Through the early psychosis movement, it was recognized that young persons are often traumatized by the onset of a psychotic disorder. This led to incorporate a trauma-informed approach to helping young people and their families with psychosis. In addition to the goal of stopping a psychotic disorder from getting worse, EPI programs have focused on elements of the recovery process that exceeded most mainstream mental health services. As such, EPI became a vehicle for system reforms such as:
- Emphasizing hope as a central message to convey to clients/families and professionals
- 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/caregivers and paying attention to social contexts
- Emphasizing the importance of engagement in treatment by using minimal doses of medications
- Promoting self-management
- The explicit use of clinicians to assist with the psychological, social and environmental elements of recovery
Several vital features have set EPI services apart from standard mental health teams:
- Acceptability of young people (bridging the crucial teen to young adult years)
- Accessibility, reduced waiting times/lists for assessment and treatment
- Non-stigmatizing approaches in all program components
- Collaborative treatment planning
- Holistic approach committed to improving functional, social, symptomatic, and vocational outcomes
- Proactive to initiate early, appropriate treatment including the assertive early identification and treatment of refractory cases
- Engagement and including family/caregivers from the start
- Addressing the specific needs of people with first-episode psychosis
- Assertive vocational rehabilitation
Many of these facets of EPI-related work are consistent with the goals of the emerging persons with lived experience-defined recovery orientation. EPI services strive to use the most effective ways they can, to support people achieve the best lives possible.
Slade, M. (2009) The contribution of mental health services to recovery. Journal of Mental Health, 18(5): 367-371.